Report
to
The LEGISLATIVE FINANCE COMMITTEE

Corrections Department
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007
Report #07-04

LEGISLATIVE FINANCE COMMITTEE
Senator John Arthur Smith, Chairman
Representative Luciano “Lucky” Varela, Vice Chairman
Senator Sue Wilson Beffort
Representative Donald E. Bratton
Senator Pete Campos
Senator Joseph J. Carraro
Senator Carlos R. Cisneros
Senator Phil A. Griego
Senator Timothy Z. Jennings
Representative Rhonda S. King
Representative Brian K. Moore
Senator Leonard Lee Rawson
Representative Henry “Kiki” Saavedra
Representative Nick L. Salazar
Representative Jeannette O. Wallace

DIRECTOR
David Abbey
DEPUTY DIRECTOR FOR PERFORMANCE AUDIT
Manu Patel, CPA

PERFORMANCE AUDIT REVIEW TEAM
Susan Fleischmann, CPA
Bobby Griego
Consuelo Mondragon
Sylvia Padilla, CFE
J. Scott Roybal
Charles Sallee
Aurora B. Sánchez, CISA
Brian Schuss
Usha Shannon

Table of Contents
Page No.
EXECUTIVE SUMMARY ....................................................................................................... 1
BACKGROUND INFORMATION ......................................................................................... 7
FINDINGS AND RECOMMENDATIONS .......................................................................... 15
NEW MEXICO’S PRIVATE PRISONS COST MORE THAN OTHER STATES,
BUT IMPROVED CONTRACTS AND BETTER MONITORING COULD SAVE
TAXPAYERS MILLIONS............................................................................................................... 15
NEW MEXICO’S APPROACH TO PRISON PLANNING AND CONSTRUCTION
IS NOT IN THE TAXPAYERS’ BEST INTEREST ..................................................................... 26
THE DEPARTMENT NEEDS BETTER OVERSIGHT TO CONTAIN MEDICAL
COSTS AND ENSURE THE PROVISION OF ADAQUATE CARE ......................................... 33
MORE INFORMATION IS NEEDED TO DETERMINE BOTH THE QUALITY AND
EFFECTIVENESS OF THE DEPARTMENT’S INPATIENT ADDICTIONS SERVICES .... 37
THE DEPARTMENT DOES NOT REGULARLY ASSESS THE IMPACT OF
MENTAL HEALTH SERVICES ON INMATES’ ABILITY TO FUNCTION IN
A PRISON ENVIRONMENT OR SOCIETY UPON RELEASE ................................................ 43
THE DEPARTMENT ENSURES BASIC COMPLIANCE WITH POLICIES BUT
COULD IMPROVE PRISON OPERATIONS FURTHER BY INCREASING ITS
FOCUS ON PERFORMANCE........................................................................................................ 47
IMPROVED MONITORING OF FOOD SERVICE CONTRACTS COULD REDUCE
COSTS AND INCREASE DEMONSTRATED QUALITY.......................................................... 49

APPENDIX A ........................................................................................................................... 52
APPENDIX B ........................................................................................................................... 54
DEPARTMENT RESPONSES

EXECUTIVE SUMMARY
NMCD Inmate
Population Growth
1978 - 2017
10,000
9,000
8,000
7,000
6,000

On February 2, 1980, inmates overpowered four correctional officers at
the Penitentiary of New Mexico beginning what would become one of
the nation’s bloodiest prison riots. Thirty-six hours later, 33 inmates
were dead and another 90 were being treated for injuries. All 12
correctional officers held hostage survived the chaos. The results of an
investigation by Attorney General Jeff Bingaman indicated that
overcrowding, lack of trained security staff, inconsistent policy
enforcement, a disciplinary system reliant on “snitches,” failure to
separate predatory inmates from others and an overall lack of incentive
programs, such as education, were conditions leading to the prison riot.

5,000
4,000
Act ual

Project ed

3,000
2,000
1,000

20
08

19
98

19
88

19
78

0

Source: NM CD

All NMCD facilities meet
national standards.
Corrections Dept.
Operating Budget
FY00 - FY08
$300
$280
$260

(In millions)

$240
$220
$200
$180
$160
$140
$120
$100
FY00

FY03

FY06

Source: NM CD

New Mexico began a long, expensive and massive prison construction
process and expansion of services for inmates. The bloody riot and the
Duran federal consent decree profoundly affected the design and cost of
prison facilities and the services provided. Since 1980, the number of
state inmates has increased over 440 percent to 6,574; the number of
prisons has increased from one to 12, including six privately operated
prison facilities; and corrections appropriations approach $300 million
going into FY08.
Today, the Corrections Department (department) operations and all
facilities meet national standards; one of only six states receiving full
accreditation by the American Correctional Association (ACA).
Legislative Finance Committee (Committee) staff commends the
department for this achievement. However, public concerns continue
regarding the cost, quality, adequacy and effectiveness of New
Mexico’s prison operations. The review assessed the department’s
oversight of basic medical, mental health, addiction and food services to
inmates; the impact and costs of contracted (private) prison facilities;
and the adequacy of facility planning efforts in light of the projected 40
percent increase in the prison population over the next ten years.
New Mexico’s inmate population resides in relatively safe, clean,
professionally operated prisons and has access to expanded medical and
behavioral health services. The department is well positioned to
continue improving prison operations, but needs a more comprehensive
approach to planning, oversight and evaluating not only the quality of
prison services but their effectiveness. Historically, the department has
not fared well negotiating cost-effective contracts for private prisons
and medical services, nor has it provided strong monitoring. Overall,
these deficiencies and a seemingly endless increase in prison population
have resulted in unsustainable growth in costs to New Mexico
taxpayers.

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May 23, 2007

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Significant findings.
Percent Change in
Prisoners and
Expenditures at Private
Prisons
FY01 to FY06
60%
57%

50%
40%
30%
20%

21%

10%
0%
Inmates

Expenditures
Source: NM CD

The department pays
significantly higher rates to
house inmates in private
prisons than other states.

NMCD Out-of-System
Bed Use
March 2007

New Mexico’s private prisons cost more than they should due to
contract price increases. New Mexico houses 42 percent of its state
inmates in private prisons which is the highest rate of private prison use
in the nation.
• State spending on private prison contracts has increased 57
percent since 2001, largely due to contract price increases.
Private prison contracts provide an automatic price increase
based on the Consumer Price Index (CPI) subject to a fivepercent cap. Past adjustments to the structure of per diems by
then Governor Johnson’s administration have resulted in the
department exceeding the contracts’ five percent cap in some
years.
• The department pays significantly higher rates to house inmates
in private prisons than other states for similarly classified
prisoners. Other state’s per diem rates include medical costs.
Neighboring states do not renew private facilities contracts
based on CPI.
• Providing price increases on fixed private prison construction
costs may result in New Mexico paying, at a minimum, an
estimated $34 million more than it should over twenty years to
Lea and Guadalupe counties. In 2000, the Independent Board of
Inquiry (IBI) review noted the contractual flaw of providing
inflationary price increases on fixed construction costs. The
department has not corrected these agreements. The department,
nor the contract, ensures LCCF and GCCF use price increases
only for operational costs.

Restructuring agreements could lower private prison costs an
estimated $60 million during the next ten years without sacrificing
3,500
3,784
quality and safety.
3,000
• Restructure per diems to take advantage of economies of scale
2,500
2,790
and separate facility use fees. The department’s original
2,000
agreements with Lea and Guadalupe counties appropriately
1,500
considered economies of scale generated by filling facilities to
1,000
90 percent occupancy, but were changed in 2001. The
500
department’s agreement with Clayton provides a model per diem
0
structure. The Clayton agreement includes a base operating fee,
Contract
Public
(Private)
Source: NM CD
incremental per diem and a separate facility use per diem. Using
this three-tier per diem model for Lea and Guadalupe county
agreements could result in annual estimated savings of at least
The department’s agreement
$4.9 million or $49 million over the next ten years. The
with Clayton provides a
department could save an additional estimated $11 million over
model per diem structure.
the next ten years by not increasing facility use per diems.
Number of Inmates

4,000

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•

The department lacks active
long-term planning to
accommodate inmate
growth.

Contracting outside of the
Procurement Code for
private prisons puts the state
in a poor negotiating
position.

Current law limits the
department’s flexibility to
obtain prison space at a
more affordable price.

Require private prisons to justify annual price increases based
on performance and improve management of savings created by
staff vacancies at private facilities. Facilities often run high
vacancy rates, which do not benefit the department
programmatically or financially.

New Mexico’s approach to prison planning and construction is not
in the taxpayers’ best interest. The department projects its inmate
population will increase 37 percent by 2016, requiring bed space for an
estimated 9,365 inmates. Despite additional facilities in Clayton,
Springer and Albuquerque the department may face overcrowding
between 2009 and 2011. The department lacks active long-term
planning to accommodate inmate growth, leading to a disjointed
approach to acquiring bed space that proves costly.
• Rapid deterioration and an inefficient design make New
Mexico’s public prison facilities increasingly expensive to
operate. The department may require an estimated $100 million
in capital outlay funding to repair public facilities statewide over
the next five years. Upgrading these housing units may not make
fiscal sense because of the higher costs to staff these small units.
• New Mexico’s use of county jail statutes as the basis for building
private state prisons results in the state paying for a prison it
will never own, including prisons in Clayton, Lea and
Guadalupe counties.
• Not using traditional state capital outlay financing for prison
construction results in higher long-term costs for the state
taxpayer. For example, the prison in Clayton will cost about $61
million to construct but the department will pay $132 million
over twenty years for construction and financing charges
through higher per diems rates, but it still will not own the
facility.
• Contracting outside of the Procurement Code for both the use
and operation of prison facilities puts the state in a poor
negotiating position.
• Current law limits the department’s flexibility to obtain prison
space at a more affordable price. The law also does not require
that private prison operations will cost less than if the
department operated the same facility.
• Other alternatives exist to finance prison construction that
would be more beneficial to the department and state taxpayer.
The department needs better oversight to contain medical costs and
ensure the provision of adequate care. The department has not
effectively monitored the cost of medical services and has struggled to
enforce key contract provisions, such as staffing requirements, despite
applying nearly $90 thousand in financial penalties. Committee contract

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The quality of medical care
is inadequate.

More information is needed
to determine the
effectiveness of addictions
services.

medical experts concluded that Wexford's health care staff includes
many highly qualified professionals, but the quality of the care provided
is inadequate. The quality of inmate care is hampered by deficiencies in
staffing, policies, protocols, record keeping, data collection, and
communication systems. In addition, the department's oversight and the
quality improvement program have failed to identify problems in a
timely fashion. At the time of this report, the department terminated its
contract with Wexford and was in the process of soliciting bids for a
new medical contract. Committee medical experts found the following.
• Wexford’s insufficient record-keeping, the lack of meaningful
and consistent reports and poor communication between
Wexford and the department has limited oversight of access to
care, particularly for off-site specialty care.
• The department’s lack of a medical director during part of 2006
greatly compromised its oversight responsibility for quality of
care.
• The geriatric housing unit at the Central New Mexico
Correctional Facility is counter-therapeutic.
• Wexford’s chronic illness program fails to meet national
standards, resulting in poor medical outcomes for inmates.
Inmates generally have sufficient access to behavioral health
services, but better monitoring is needed to ensure the effectiveness
of services.
• The department does not regularly assess the impact of mental
health services on inmates’ ability to function in a prison
environment or society upon release.
• More information is needed to determine both the quality and
effectiveness of the department’s inpatient addictions services.
The department ensures basic compliance with policies but could
improve prison operations further by increasing its focus on
performance.
• The department does not measure or monitor performance in key
aspects of prison operations such as its inmate classification
system. ACA is moving towards performance-based
accreditation that will require the department to demonstrate not
only compliance but the performance of its prisons.
Key Recommendations. Modify department agreements for private
correctional facilities.
• Restructure Lea and Guadalupe county rates using a three-tier
per diem to include a base per diem (existing per diem less
recalculated debt service), incremental per diem (about 30
percent of base per diem) and a separate debt service fee. Reduce
past price increases in recalculating the debt service fee. This

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•
•

per diem will mirror the Clayton agreement and save an
estimated $4.9 million per year.
Align incremental per diems for NMWCF and Camino Nuevo to
eliminate cost increases associated with transferring inmates to
Albuquerque.
Withhold no less than five percent of the total estimated contract
amount as a performance incentive for maintaining low vacancy
rates. Automatically deduct penalty amount for unfilled security
positions after 30 days. Require private prisons to justify annual
price increases based on meeting performance measures.

Committee staff proposes the following statutory changes.
• Require the department to develop and implement a 10-year
facility strategic plan and submit the plan to the Courts,
Corrections and Justice Committee, the Legislative Finance
Committee and the Department of Finance and Administration
no later than November 1 of each even-numbered year.
• Amend state law to remove restrictions on the location or type of
correctional facility for which the department may award a
prison contract. Add provisions to prohibit the department from
entering into agreements with a prison operator that also owns
the facility. Require the department to demonstrate that private
operation of the facility would cost at least ten percent less than
if the department operated the facility (Section 33-1-17 NMSA
1978).
• Consolidate multiple prison construction funds into one New
Mexico prison fund, remove restrictions that require use of
revenue for prisons in certain locations or type of correctional
facility and remove authority to use the fund proceeds for
operating leases (Sections 33-1-18 and 33-1-19 NMSA 1978).
• Authorize the department to procure private or locally financed
correctional facilities by entering into lease-purchase
agreements, subject to legislative approval as provided by Laws
2007, Chapter 184 (H.B. 1022).
Throughout the interim, legislative committees could
alternatives for prison financing, including whether to
revenue bond authority to the New Mexico Finance
prisons or creating a public corporation to own
correctional facilities.

explore other
grant specific
Authority for
any financed

The department should:
• Implement recommendations from Committee medical experts
included in Appendix B.
• Limit medical contract annual price increases to no more than
the medical service CPI based on meeting certain performance
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•

•

targets; withhold no less than five percent of the total estimated
contract amount as a performance incentive for maintaining low
vacancy rates; and include automatic financial penalties for
excessive staff vacancies, particularly for critical professions
such as physicians and dentists.
Require the medical vendor to provide monthly reports on
medical spending by defined expense categories and staff
vacancies by type of staff. These should be submitted with
invoices.
Begin collecting and reporting program outcome and
performance information for addictions and mental health
services. The Committee and Legislature should reconsider
funding increases for addictions services until the department
completes and implements the recommendations related to
addictions services.

Corrections Department, Report #07-04
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May 23, 2007

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BACKGROUND INFORMATION
AGENCY AT A GLANCE
The mission of the New Mexico Corrections Department (department) is to provide a balanced
systems approach for corrections, from incarceration to community-based supervision. The
department operates under six strategic goals, including the following.
•
•
•
•
•
•

Provide a balanced system approach to all offenders.
Optimize population control management.
Provide a comprehensive approach to female offenders.
Lower cost of corrections.
Reduce exposure to litigation.
Enhance public relations and education efforts.

FAST FACTS
Inmate Population & Growth – The department housed 5,945 male inmates and 629 female
inmates as of March 2007. The male inmate population grew 10 percent during FY06, and the
female population grew eight percent based on LFC budget analysis. The department projects the
total inmate population will grow to over 9,300 by 2016.
Funding – The department operates on an FY07 budget of $262 million with FY08
appropriations totaling $299 million.
Prison Facilities – The department operates six public facilities located throughout the state. In
January 2007, the department opened a public facility for level I and II male inmates at Springer
Correctional Center, formerly the New Mexico Boys’ School.
Private Prisons – Nationally, New Mexico places the highest percentage, about 42-44 percent,
of inmates in private prisons. The national average is 6.5 percent.
HISTORY OF MAJOR EVENTS
1854

1885
1897
1912
1939

The Territorial Legislature authorized the construction of a Territorial Penitentiary on
the site of the current federal courthouse in Santa Fe. The construction was halted
due to citizen opposition to its location and a lack of funds.
Penitentiary of New Mexico was completed at a cost of $150,000 and included 104
cells. PNM was located in Santa Fe at Cordova and Penn Roads.
Prison overcrowding required inmates to be housed in yard buildings.
New cell house completed at PNM, but the state still faced overcrowding.
Honor Farm, an unrestricted minimum security facility in Los Lunas, was built as a
satellite of PNM and produced all inmate food. Pattern of overcrowding continues
through the 1950s.

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1953
1956

1958
1969

1977

1980
19802000

20012007
2008

Riot erupts at PNM, the fourth major violent incident in a year and prompted public
outcry for a new penitentiary.
New Penitentiary of New Mexico opened ten miles south of Santa Fe. At the time,
the “new” PNM was considered one of the nation’s finest corrections structures and
cost $8 million to construct. The state closed the Main unit in 1998.
PNM faced overcrowding. Between 1956 and 1969 eleven inmates escaped.
Department of Corrections and Police Academy formed, combining PNM, the New
Mexico Boys School, the Girls Welfare Home and the Board of Adult Probation and
Parole into one organization.
Inmate Dwight Duran filed a federal class action lawsuit on behalf of other inmates
claiming unconstitutional living conditions. The state accepted a federal consent
decree in 1979 that would govern much of the department’s operations for two
decades.
Riot at the Penitentiary of New Mexico resulted in the death of 33 inmates and injury
to another 90. Twelve correctional officers taken hostage survive.
The state built three new correctional facilities in Los Lunas, Las Cruces and Grants,
and expanded PNM. Private facilities were constructed in the 1990s in Torrance,
Santa Fe, Lea and Guadalupe counties and the private women’s facility in Grants was
expanded.
The department takes over juvenile facilities at Springer and Albuquerque from the
Children, Youth and Families Department.
The department will open a private facility in Clayton bringing the total number of
facilities to 13.

Riot at the Penitentiary of New Mexico
February 2-3, 1980
Pre-Riot
The department had four Cabinet Secretaries from 1976-1980 and experienced significant
overcrowding conditions. Correctional staff became more reliant on coercion as the primary
method of inmate control as incentive programs were removed. In 1980, the Secretary of
Corrections offered his resignation after eleven inmates escaped from PNM, but inmate unrest
continued. Officials discussed intelligence revealing other planned escapes and race riot, and
pinpointed Dormitory E-2 as a possible problem area due to the high number of requests for
inmate transfers out of the housing unit.
Riot
In the early hours of Saturday, February 2, inmates overpowered four correctional officers in
Dormitory E-2, beginning what would become one of the nation’s bloodiest prison riots. The
inmates took keys from the officers and proceeded to open other housing units and eventually
broke through newly installed shatter-proof security glass at PNM’s central control center.
Inmates began destroying the prison through fire and floods and broke into the infirmary
seeking drugs. Other inmates began searching for enemies and ended up opening other
cellblocks, including cellblock 4 which housed the “snitches” and other inmates in protective
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custody. Brutal violence ensued. Many inmates fled the violence by going outside. By 1:20
PM on February 3, State Police and the National Guard began to retake the badly damaged
prison.
The takeover and riot lasted 36 hours. All 12 correctional officers held hostage survived the
chaos. Thirteen officers were responsible for over 1,100 inmates that night. A total of 33
inmates were killed by fellow inmates; some were tortured and their bodies mutilated.
Another 90 were treated for injuries from beatings, stabbings and rapes by other inmates.
Post-Riot
The results of an investigation by Attorney General Jeff Bingaman indicated that
overcrowding, lack of trained security staff, inconsistent policy enforcement, a disciplinary
system reliant on “snitches,” failure to separate predatory inmates from others and an overall
lack of incentive programs, such as education, were conditions leading to the prison riot.
Extreme levels of violence continued after the riot. Two correctional officers and seven
inmates were killed during the 18 months that followed the riot. Inmate disturbances, including
fires and flooding, and attacks, beatings and stabbings continued on the regular basis both at
PNM and at out-of-state prisons holding New Mexico inmates. Many of the attacks were in
retaliation to the riot. PNM struggled to staff the facility due to high numbers of resignations
and retirements. Some officers refused to go back inside PNM until the administration
addressed grievances related to pay, understaffing and lack of supervision and training.
Source: NMCD and the Albuquerque Journal.

ORGANIZATION
Office of the Secretary. The Secretary of Corrections acts as the department’s chief executive
and operations officer. The appointed Secretary serves at the pleasure of the Governor and must
be confirmed by the Senate. The Secretary has authority to adopt necessary rules and
regulations; appoint, with the governor’s consent, division directors; and carries out other duties
needed to operate the department.
Staff. In FY07, the department had 2,467 authorized FTEs. Staff is located throughout the state
in prison facilities, probation and parole offices and the Santa Fe central office.
Operations. The department consists of six divisions and numerous bureaus. State law provides
for the following divisions: adult prisons, probation and parole, correctional industries, training
academy, administrative services and information technology.
Inmate Management and Control. This budget program is the largest of the department’s
programs, consisting of over 1,800 FTEs and an FY07 operating budget of over $209 million.
The program includes the Adult Prisons Division, which oversees over 6,600 inmates housed in
twelve different facilities: six public prisons and six private facilities. The division ensures these
facilities provide secure, safe, humane and cost-effective operations, including housing, food,
health-related services and other quality of life services.

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Table 1. Corrections Department Prison Facilities
Type of Correctional Facility

Inmate
Classification

Bed
Capacity

FY06 Avg.
Daily Pop.

II, V, VI

906

902

I, II, III, IV

1382

1365

II, III, IV

810

835

II, III, IV

428

413

II

340

336

II

264

#

NA

I, II

192

85

III

1264

1272

III

601

603

III

144

150

III

213

212

I – VI

612

594

III

600

NA

Public Facilities
Penitentiary of New Mexico (PNM) - Santa Fe
Central New Mexico Correctional Facility
(CNMCF) - Los Lunas
Southern New Mexico Correctional Facility
(SNMCF) - Las Cruces
Western New Mexico Correctional Facility
(WNMCF) - Grants
Roswell Correctional Center (Roswell)
Springer Correctional Center (Springer)*
Private Facilities
Camino Nuevo Correctional Center (CNCC) Albuquerque
Lea County Correctional Facility (LCCF) Hobbs
Guadalupe County Correctional Facility
(GCCF) - Santa Rosa
Santa Fe County Detention Facility (SFCDF)
Torrance County Detention Facility (TCDF) Estancia
NM Women’s Correctional Facility (NMWCF) Grants
Northeastern New Mexico Detention Facility –
Clayton*

Source: NMCD
*Springer opened January 2007 and Clayton will open in 2008. # Bed space, but as of May 2007 operational capacity was 80.

New Mexico Correctional Facilities’ Locations*
As of December 2006

Source: NMCD

*In 2006 the department expanded its capacity to one private facility in Albuquerque, in 2007 to one public facility in Springer; and in
2008, one private facility in Clayton. These facility locations are not reflected on the map above.

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Health Services. The department contracts with Wexford to provide all medical, dental and
psychiatric services to inmates throughout its prison system (public and private). Wexford
provides onsite physician and nursing staffing and quality assurance management of health
services. Wexford subcontracts for off-site care such as hospitalization and specialty consults
with local providers. The FY07 contract is estimated at $38 million.
Department central office staff conducts contract monitoring and quality assurance audits of
Wexford. The department works with the University of New Mexico ECHO program to treat
inmates with Hepatitis C. The department purchases its most expensive pharmaceutical drugs
for inmates with Hepatitis C or HIV/AIDs through a discount program managed by the
Department of Health.
Mental Health Services. The Mental Health Services Bureau provides and oversees all mental
health services, except psychiatric care, for inmates. About 20 percent of department inmates
receive some type of mental health service. The program operates on a $4.1 million budget in
FY07 and is staffed by 74 clinicians (counselors, social workers and psychologists). Psychiatrists
and the provision of psychotropic drugs are delivered through the department’s medical vendor
and overseen by a department psychiatrist in the Health Services Bureau. Mental health services
at private facilities are carried out by the contractor, but the bureau is still responsible for
ensuring quality of care.
All inmates entering the system are assessed for mental health disorders and have access to a
range of mental health services. Mental health staff provides diagnostic assessment, basic
therapy (individual and group), participates in medication management and conducts crisis
interventions. The department operates a 104-bed inpatient acute care mental health unit and an
alternative placement area unit for inmates that cannot function safely in general population.
The Bureau is also responsible for sex offender treatment programs.
Table 2. Mental Health Services Statistics
4th Quarter – CY06
Number of Inmates System-wide
Mental Health Total Caseload (Individual, Group, and/or Medication)
Individual & Group Treatment
Psychotropic Medications
Community Reintegration (Sex Offender Treatment)
Psycho-Educational Groups (Number of Inmates)
Number of Mental Health Contacts
Avg. Number of Contacts per Clinical Staff Member (Quarter)

6,630
1,419 (21.4%)
514 (7.8%)
1,286 (19.4%)
132
457
35,028
459
Source: NMCD

Addiction Services. The department provides comprehensive substance abuse services, including
outpatient counseling, self-help groups, and inpatient treatment called therapeutic communities
(TC). Addictions Services employs 42 people and has an FY07 operational budget of about $3.7
million. Comprehensive services are also provided in contracted private facilities but spending is
imbedded into the overall contracted per diem rate. According to the department about 60-75
percent of its inmate population meets the criteria for substance dependence and about 85 percent
have a history of substance abuse. Nationally, about 81 percent of state inmates’ criminal
behavior revolved around drugs and alcohol in one way or another; either through use/abuse,
sell/buy, drunk driving, etc, according to national studies.
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Chart 1. Theraputic Community Pariticpant
Drug of Choice - 2004

Meth, 231,
13%

Alcohol, 901,
49%

Heroin, 132,
7%
Marij., 220,
12%
Cocaine, 329,
18%

Other, 14, 1%
Source: NM CD

In 1994, Congress funded Residential Substance Abuse Treatment (RSAT) grants for intensive
residential substance abuse programs at state prisons to address the increasing numbers of
offenders with substance abuse problems. A federal RSAT evaluation noted that funds were
used to dramatically expand the number of inmates receiving services, but expressed concern
over the structure of many programs. However, according to the federal Office of Management
and Budget, “evaluations of prison-based treatment programs show that drug dependent inmates
who complete treatment are significantly less likely to return to drugs and crime following
release, compared to inmates who receive no treatment.”
FUNDING
Fiscal year 2008 appropriations total about $299 million in general fund revenue and other
sources, such as income from the permanent land grant fund, up from $262 million for FY07.
The department has five budget programs, with Inmate Management and Control accounting for
82 percent of all expenditures in FY06.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

12

Chart 2. Corrections Department
Operating Budget
Fiscal Years 2000 - 2008
$300,000
$280,000

(In thousands)

$260,000
$240,000
$220,000
$200,000
$180,000
$160,000
$140,000
$120,000

08

06

07

FY

FY

05

FY

03

04

FY

FY

02

FY

01

FY

FY

FY

00

$100,000

Source: NM CD

Chart 3. Corrections Department
Expenditures by Program - FY06
Community
Offender
Management,
23,624.2, 10%

Community
Corrections,
3,986.8, 2%

Program
Support, 8,526.3,
3%

Corrections
Industries,
5,279.6, 2%

Inmate
Programming,
10,559.7, 4%

Inmate
Management &
Control,
194,627.9, 79%
Source: NMCD

Review Objectives.
• Review the department’s oversight of costs and the provision of basic medical, mental
health, addiction and food services to inmates. The food service contract for the Training
Academy was reviewed at the request of the department.
• Assess the impact of contracted facilities on department operations and costs.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

13

•

Determine the accuracy of prison population projections and adequacy of the
department’s facility and program planning efforts.

Review Activities (Scope and Methodology).
•
•
•
•
•

Reviewed and analyzed statutes, laws, administrative rules and department policies.
Conduct field visits to department correctional facilities, including PNM, SNMCF,
WNMCF, CNMCF, NMWCF, GCCF, LCCF and SFCDC.
Interviewed staff from the department, its contractors and other states’ correctional
departments; General Services Department and New Mexico Finance Authority.
Interviewed state inmates.
Conducted research on best practices and other states’ prison systems.
Reviewed contracts, performance measures, data, budgets, state plans, and reports
provided by the department, other state and federal entities and LFC documents dating
back to 1980.

Review Authority. The Committee has authority under Section 2-5-3 NMSA 1978 to examine
laws governing the finances and operations of departments, agencies, and institutions of New
Mexico and all of its political sub-divisions, the effect of laws on the proper functioning of these
government units, and the policies and costs of government. Pursuant to its statutory authority,
the Committee may conduct performance reviews and inquiries into specific transactions
affecting the operating policies and costs of governmental units and their compliance with state
law.
Review Team.
Manu Patel, Deputy Director for Performance Audits
Charles Sallee, Performance Auditor
Usha Shannon, Performance Auditor
Bobby Greigo, Performance Auditor
Dr. Steven Spencer, Contract Medical Expert
Dr. Jaye Anno, Contract Medical Expert
Exit Conference. The contents of this report were discussed with Secretary Joe Williams and
senior Corrections Department staff on May 17, 2007.
Report Distribution. This report is intended for the information of the Office of the Governor,
the Corrections Department, the Department of Finance and Administration, the Office of the
State Auditor, the Courts, Corrections and Justice Committee and the Legislative Finance
Committee. This restriction is not intended to limit distribution of this report which is a matter of
public record.

Manu Patel
Deputy Director for Performance Audits
Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

14

FINDINGS AND RECOMMENDATIONS
NEW MEXICO’S PRIVATE PRISONS COST MORE THAN OTHER STATES, BUT
IMPROVED CONTRACTS AND BETTER MONITORING COULD SAVE
TAXPAYERS MILLIONS.
Currently, New Mexico houses 42 percent of its state inmates in private prisons, which is
the highest rate of private prison use in the nation. In 2005, five states had at least 25 percent
of their prison population housed in private prisons, led by New Mexico (43 percent), Wyoming
(41 percent), Hawaii (31 percent), Alaska (28 percent), and Montana (26 percent), according to
the U.S. Bureau of Justice Statistics.
As of March 2007, the department housed 2,790 or 42 percent of its state inmates in local jails or
private facilities, also called out-of-system beds.
Chart 4. NMCD Out-of-System Bed Use
March 2007
4000
Number of Inmates

3500

3,784

3000
2500

2,790

2000
1500
1000
500
0
Contract (Private)

Public
Source: NM CD

State spending on private prison contracts has increased 57 percent since 2001, largely due
to automatic contract price increases. Spending on private prisons has outpaced the number of
inmates housed in private prisons. Between FY01 and FY06 annual spending on private prisons
increased 57 percent from $34 million to $54 million. However, the number of inmates only
increased 21 percent, from 2,348 to 2,840, during the same time period, as shown in Chart 5.
Increases in private prison per diem rates for FY03-FY07 are shown in Chart 6.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

15

Chart 5. Percent Change in
Prisoners and Expenditures at
Private Prisons
FY01 to FY06
60%
57%

50%
40%
30%
20%
21%
10%
0%
Inmates

Expenditures
Source: NM CD

Chart 6. Private Prison Per Diem
Rate Comparison
FY03 through FY07
$62
$60
Per Diem Rates

$58
$56
$54
$52
$50
$48
$46

FY03

FY04

FY05

FY06

FY07

LCCF

$51.75

$53.55

$54.75

$56.58

$58.53

GCCF

$54.71

$56.49

$57.53

$58.34

$60.35

SFCDF

$53.30

$55.30

$57.30

$58.54

$60.55

TCDF

$51.04

$51.90

$53.06

$54.21

$56.07
Source: NM CD

Automatic contract price increases limit the department’s ability to control cost increases. The
department annually increases prison contracts by an amount equal to 80 percent of the consumer
price index (CPI) or other increase up to a five percent cap. Department staff asserts that using
80 percent of CPI was its attempt to avoid providing price increases on construction costs, but
could not provide supporting documentation. The CPI calculation only provides the basis for
determining the amount of the price increase, not how the increased payments will be applied.
The contracts are silent on this issue. As such, the department has increased the entire price of
the contract amount. The department does not monitor the contractor’s expenditures to ensure
these increases are applied to operational costs (non-debt service) and do not provide excessive
price increases. The CPI measures changes in the average price of consumer goods and services
Corrections Department, Report #07-04
16
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

purchased by wage earners in urban areas. In addition to a cost-of-living index the CPI is used to
measure the rate of inflation.
The department has not always correctly applied price increases based on the contract. During
our review, we noted that the department used the wrong CPI for two years, FY05 and FY06.
For FY05, the department under paid by using an incorrect CPI of 2.3 percent instead of 3.3
percent. The department overpaid in FY06 by using 2.7 percent as the CPI instead of the correct
2.5 percent.
The department did not use the same base year to calculate CPI increases, resulting in some
facilities getting a bigger increase than others. The department used the state fiscal year as the
basis for determining CPI, but used calendar year for GCCF until 2005. The department tried to
align all facilities’ contracts to the same year, but ended up granting GCCF two price increases in
one year. On January 1, 2005, the GCCF contract price was increased from $56.49 to $57.53
and then again on July 1, 2005, from $57.53 to $58.34. As a result, the department paid about 81
cents more in per diem than it should, which costs the state about $89 thousand extra, based on
an average of 600 inmates.
Adjustments to the structure of per diems have resulted in the department exceeding the
contract’s five-percent cap in some years. Under Governor Johnson’s administration, the
department provided price increases that exceeded the contracts’ maximum five-percent annual
renewal per diem rate. Table 3 shows per diem rates of LCCF and GCCF from the inception of
the contracts.
Table 3. Per Diems - FY98 to FY06

Contractor
Level of Security
Inmates

LCCF
GEO
III
1200

GCCF
GEO
III
600

FY98

1-1140 @ $42.5
>60 @ $12.5

NA

FY99

1-1080 @ $44.15
1081-1140 @ $42.50
>1141 @ $12.50

NA

FY00

1-1080 @ $46.36
1081-1140 @ $44.71
>1141 @ $13.12

1-570 @ $47.5
571-600 @ $15.00

FY01
FY02
FY03
FY04
FY05
FY06

1-1080 @ 48.68
1081-1140 @ $47.03
>1141 @ $13.78
$51.30
$51.75
$53.55
$54.75
$56.58

$53.00
$53.68
$54.71
$56.49
$57.53
$58.34
Source: NMCD

NA = Not applicable because the facility became operational in FY99.
Note: NMCD used July CPI to renew LCCF per diem and January CPI to renew GCCF per diem
during FY05 and prior years.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

17

In FY02, the department changed multiple per diem rates for housing inmates at LCCF to a
single per diem rate, resulting in an almost 13 percent increase. The department adjusted the
GCCF per diem rate in a similar fashion in FY01, resulting in more than a 15 percent increase in
per diem rate. The department indicates these changes were necessary to pay for facility
upgrades and additional security staff after the riot and inmate disturbances.
No other neighboring states renew private facilities’ contracts based on CPI. Contracts between
private prison operators and the states of Colorado, Montana, Texas, Idaho, and Oklahoma do
not include automatic price increases tied to CPI. Instead, either the contracts are subject to
direct legislative appropriations for price increases, or price increases are fixed and established at
the beginning of the contract term. This approach has held down price increases for these other
states or actually resulted in decreased per diem rates. For example, Colorado decreased its per
diem for one facility from $54.66 in FY03 to $50.28 in FY06. Other states have experienced
minimum per diem increases as shown in Table 4 below.
Business decisions across two administrations may result in New Mexico paying an
estimated $34 million more than it should for private prison construction costs. To date the
department has paid, at a minimum, an estimated $5.7 million more than it should have for
private prison construction costs at LCCF and GCCF.
The department’s contracts with Lea and Guadalupe counties do not include a separate per diem
for facility debt service or lease costs. In the late 1990s, Wackenhut (now GEO, Inc.) privately
financed the construction of prisons in Lea and Guadalupe Counties, after failed attempts to use
county-issued revenue bonds. The state had an opportunity to purchase these facilities in the late
1990s, but the Legislature and Governor Johnson could not come to an agreement over the
direction of prison privatization.
The costs of construction, private capital and GEO’s return on its investment are captured in the
overall per diem rate (we use debt service to explain construction and return on investment).
According to GEO, the company reported about $27 million constructing GCCF and $50 million
constructing LCCF as of 2001. Separating these costs is not necessary for the Torrance and
Santa Fe County agreements because those facilities are multi-jurisdictional facilities, housing
jail inmates as well as federal inmates. In addition, the department does not use the vast majority
of bed space in those facilities as it does at LCCF and GCCF.
Since the department has not segregated the facility per diem, it has ended up providing a price
increase on what should have been fixed costs. Again, the contract does not require the
contractor to spend revenue from price increases on operational costs. As a result, the state has
been providing price increases on estimated fixed costs of $10.04 for LCCF and $10.85 for
GCCF. Through FY06, the difference between the estimated debt service and the price increases
is $4.4 million for LCCF and $1.3 million for GCCF. We calculated the fixed cost based on a
minimum of 540 inmates at GCCF and 1,080 inmates at LCCF because the state has committed
at the inception of the contracts to use a minimum of 90 percent of bed space. The application of
price increases on the debt service may cost state an additional $21.9 million dollars for LCCF
and $12.1 million for GCCF over twenty years from the inception of the contracts. These figures
include five percent return on investment or finance charges. See Appendix A for additional
information on methodology and assumptions used for estimates. Charts 7 and 8 show the actual
Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

18

facility debt service per diem the department should pay for versus what it has and will pay due
to price increases. The figures do not include additional overpayments as a result of the
department paying the same amount in per diem for inmates above and beyond the 90 percent
threshold necessary to cover the costs of debt service. The department should not pay as much
for these inmates because, presumably, the contractor’s construction costs are covered in the first
540 and 1,080 inmates at each facility.

Chart 8. Guadelupe CCF
Estimated Facility Debt Service
FY00-FY19
$18
Estimated Per Diem

$16
$14
$12
$10

Price Increase

FY17

FY15

FY13

FY11

FY09

FY07

FY05

FY03

FY01

FY99

$8

Fixed Cost
Source : LFC analysis

$16
$14
$12
$10
$8

FY
00
FY
02
FY
04
FY
06
FY
08
FY
10
FY
12
FY
14
FY
16
FY
18

Estimated Per Diem

Chart 7. LCCF
Estimated Facility Debt Service
$18
FY99-FY18

Price Increase

Fixed Cost
Source : LFC analysis

In 2000, the Independent Board of Inquiry (IBI) review noted the contractual flaw of providing
inflationary price increases on facility debt service and construction costs. However, the
department has not amended existing agreements with GCCF and LCCF to create a separate
facility use per diem for construction and return on investment costs.
The department has addressed this problem in its new agreement with the town of Clayton. In
that agreement, the department will pay a separate facility use fee equal to the debt service costs
the town has incurred to construct and finance a new prison.
The department pays significantly higher rates to house inmates in private prisons than
other states do for similarly classified prisoners. Tables 4 and 5 compare per diem rates and
inmate-to-staff ratios of New Mexico’s two largest male private facilities (LCCF and GCCF)
with other states. The five comparison states include: Colorado, Montana, Texas, Idaho, and
Oklahoma.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

19

Table 4. New Mexico and Other States' Per Diem Rates
FY02 through FY06
1

FY02

FY03

FY04

FY05

FY06

# of Inmates
Level of Security
Operational Cost
Health Services Cost
Building Use Fee
Total
Operational Cost
Health Services Cost
Building Use Fee
Total
Operational Cost
Health Services Cost
Building Use Fee
Total
Operational Cost
Health Services Cost
Building Use Fee
Total
Operational Cost
Health Services Cost
Building Use Fee
Total

LCCF
1200
III
51.30
9.99
0
61.29
51.75
6.19
0
57.94
53.55
5.90
0
59.45
54.75
6.97
0
61.72
56.58
12.28
0
68.86

2

Idaho
1250
III
37.62
0
0
37.62
38.71
0
0
38.71
39.87
0
0
39.87
41.07
0
0
41.07
42.30
0
0
42.30

3

Oklahoma
1918
III
40.82
0
0
40.82
40.82
0
0
40.82
40.42
0
0
40.42
40.42
0
0
40.42
41.23
0
0
41.23

Texas
1100
III

4

na

na

na
26.46
7.49
0
33.95
27.00
7.66
0
34.66

1

GCCF
600
III
53.68
9.99
0
63.67
54.71
6.9
0
61.61
56.49
5.90
0
62.39
57.53
6.97
0
64.5
58.34
12.27
0
70.61

Colorado
500
III

5

na
54.66
0
0
54.66
50.37
0
0
50.37
49.56
0
0
49.56
50.28
0
0
50.28

6

Montana
500
III
42.45
0.97
9.14
52.56
43.6
0.97
9.14
53.71
43.6
0.97
9.14
53.71
43.6
0.97
9.14
53.71
44.47
0.97
9.14
54.58

Source: NMCD and other states' corrections departments
na = not available because facility did not entered into contract as yet.
1
= Lea County Correctional Facility (LCCF) and Guadalupe County Correctional Facility (GCCF) are operated by the private contractor, GEO. It houses >1200 and
> 600 inmates respectively in each facility. Health care services is contracted to another contract. 2 = The per diem rate includes health care services cost. The
facility is the only state-owned, privately run facility. The facility is built on state property by the contractor, and the does not pay for debt service because the state
owns the facility. 3 = Total per diem rate includes 39.84 (base) +0.56 (protective custody) + .42 (therapeutic community) - $0.40 if monthly average inmates per day is
at least 1,875. Protective custody rate is spread out over the whole population at the facility. The contractor agrees to a per diem reduction of $0.40 per inmate a day
across the entire population based on a monthly average daily population of 1875 inmates as measured from the first day of the month to the last day of the month.
The department has an option to purchase at the fair market value before the renewal of the contract every year. The department did not raise per diem rate in FY05.
In FY07, legislators gave 5% raise to the contractor. The department advances six months of the first year operating per diem in the amount of $3,622,500. 4 = per
diem rate includes $7.49 and $7.66 per inmate for health care cost for FY05 and FY06 respectively. The per diem rate does not include building use fee because the
5
facility is owned by the state. = The state uses one per diem rate for all private facilities. The state does not guarantee minimum number of offenders to be assigned
to contractor's facility, but the state agrees to house up to 700 offenders at any time. The per diem rate includes health care services cost. 6 = Montana pays for
health care services over and above $1000 deductible, through a separate. It comes to an average of $0.97 per inmate a day. Montana pays $9.14 is paid for
building use fee per inmate. The use fee stays the same for the life of the contract with the expectation being after 20 years the facility is paid for by Montana and it
has an option to obtain possession.

Other states’ private prisons provide similar services and, even after adjusting for medical
services, still have lower costs than New Mexico. Colorado, Oklahoma, Montana and Idaho
private facilities per diem rates, in Table 4, include medical services. The Texas per diem rate
in Table 4 includes medical services costs provided by the state’s medical vendor. New
Mexico’s medical services are provided by a separate medical vendor, but for comparison
purposes included in the per diem rates on Table 4. All facilities provide standard services,
including food, education and recreation as show in Appendix A.
New Mexico’s private facilities are more staff intensive, which could result in higher cost
services. Table 5 shows the total staff required to operate private facilities in New Mexico and
private facilities in five other states. New Mexico facilities appear to use more administrative and
support program staff than other states. Uniform staff includes security supervisor/unit
management and security/correctional officers.

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

20

Table 5. Comparison of Private Facilities’ Staffing Requirements

No. of Inmates
Total Administration
Total Security Supervisor/Unit Management
Total Security Officers
Total Unit Support/Programs
3
Total Education
Health Care
Total
Inmate to correction officer ratio
Inmate to staff ratio
Inmate to education staff ratio

LCCF
1200
25
42.8
168.4
74
22
na
321.2

Idaho
1454
19
106
91
27
19
27
289

Oklahoma
1918
20
46
226
50.05
27
26.6
395.65

Texas
1000
16.5
15.0
129.2
21.4
16.0
na
198.1

GCCF
600
18
25.4
96.8
37.6
13
na
190.8

Colorado
724
7
68
60
17
8
2
16
160

Montana
500
10
40
70
21
13
1
8
162

5.7
3.7
54.55

7.4
5.0
76.53

7.1
4.8
71.04

6.9
5.0
62.50

4.9
3.1
46.15

5.7
4.5
90.50

4.5
3.1
38.46

Source: NMCD and other states' corrections departments
na = not applicable because health care services are subcontracted to another private contractor. Idaho staffing requirements are based on twelve hour shifts for
uniformed staff. 1 = Dentist, physician, dental hygienist, psychiatrist, optometrist are sub-contractors hired by private prison contractor. 2 = Physician, dentist, dental
3
assistant, psychiatrist, optometrist are subcontractors hired by private contractor. = Education staff includes library staff, education and vocational staff.

The department paid for services it may not have received. On September 21, 2004, the
department entered into an agreement with LCCF to provide a 116-bed residential sex offender
program and agreed to pay $304,160 annually. To provide services, LCCF was required to hire
four masters’ level licensed mental health providers within 60 days of the effective date of the
agreement. The facility did not hire four additional mental health staff even though it billed for
services, based on a review of LCCF personnel documents. LCCF instead moved four existing
mental health staff to the sex offender program but did not fill the newly created vacant mental
health positions caused by the move. LCCF did not hire a new staff member until April 2005 to
provide the services. In August 2006, the department reduced the contract amount in half
because LCCF was unable to provide services to all the inmates. Table 6 shows the mental
health FTE, sex offender treatment program FTE and actual positions filled.

Table 6. Comparison of Mental
Health FTE, Sex Offender
Treatment Program FTE and
Positions Filled

10/1/04

MH
8

SOTP
0

Total
8

Filled
7

11/1/04

9

4

13

7

4/1/05

9

4

13

8

8/1/06

9

2

11

10

Source : NMCD and LCCF
MH = Mental health FTE
SOTP = Sex offender treatment program

Restructured agreements could lower private prison costs by at least $60 million during the
next ten years without sacrificing quality and safety. While private facilities clearly cost the
department less on a per-inmate basis, and should, a more aggressive cost containment strategy
could yield further savings from privatization.
Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

21

Restructure per diems to take advantage of economies of scale and separate facility use fees.
The department’s original agreements with LCCF and GCCF appropriately considered
economies of scale generated by filling facilities to 90 percent occupancy, but were changed in
2001. The department’s agreement with Clayton provides a model per diem structure for a
facility the department intends to nearly fully occupy with state inmates. That agreement
includes a base operating fee, incremental per diem and a separate facility use per diem. The
base and incremental per diems demonstrate that the department recognizes the prison operator
will only have marginal cost increases for housing inmates beyond 90 percent capacity.
Adjusting LCCF and GCCF per diems using Clayton as a model could save the department an
estimated $4.9 million annually. Using a separate facility use per diem for debt services helps
ensure the department does not provide price increases on fixed facility costs.
The incremental per diem does not make as much sense for overflow facilities at Torrance and
SFCDC since the department houses so few inmates.
Table 7. Annual Savings from Restructuring LCCF Per Diem
FY06
No. of
Inmates
1268

Annual Cost
1

Estimated Operations Cost

$44.51

Estimated Debt Service

$12.07

1268

$5,586,237.40

FY06 Actual Per Diem

$56.58

1268

$26,186,355.60

$20,600,118.20

Recommended Tiered Per Diem
2

Base Operations Cost

$44.51

1080

Incremental Operations Cost

$13.35

>1080

Total Operations Cost
Historical Debt Service

$17,545,842.00
$828,553.65
$18,374,395.65

10.04

1080

Total Cost

$3,957,768.00
$22,332,163.65

Total Savings

$3,854,191.95
Source : NMCD and LFC Analysis

1
2
3

= Number of inmates at LCCF on June 30, 2006.
= NMCD committed 90% of 1200 inmates, 1080, at inception of the contract.
= Assume 188 inmates (1268-1080=188)

Corrections Department, Report #07-04
Review of Facility Planning Efforts and Oversight of Private Prisons and Health Programs
May 23, 2007

22

Table 8. Annual Savings from Restructuring GCCF Per Diem
FY06
No. of
Inmates
Estimated Operations Cost

$44.28

591

Annual Cost

1

Estimated Debt Service

$12.30

591

FY06 Actual Per Diem

$56.58

591

$9,551,860.20
$2,653,294.50
$12,205,154.70

Recommended Tiered Per Diem
2

Base Operations Cost

$44.28

540

Incremental Operations Cost

$13.28

>540

$8,727,588.00
$247,281.66

Total Operations Cost
Historical Debt Service

$8,974,869.66
$10.85

540

$2,138,535.00

Total Cost

$11,113,404.66

Total Savings

$1,091,750.04
Source : NMCD and LFC analysis

1
2
3

= Number of inmates at GCCF on June 30, 2006.
= NMCD committed 90% of 600 inmates, 540, at inception of the contract.
= Assume 50 inmates (591-541=50)

The per diem structure for operational agreements for NMWCF and Camino Nuevo women’s
facilities also need restructuring. The department does not have sufficient flexibility to place
female inmates in locations that best suit their programming and security needs at no extra cost.
Currently, the department has significant excess capacity to house women. As of March 2007,
female inmates accounted for 78 percent of available female bed space capacity, including 570
inmates at Grants and only 52 at Camino Nuevo. Camino Nuevo is a 192 bed facility. However,
moving any women from NMWCF to Camino Nuevo would result in a cost increase due to the
structure of each facility per diem. For example, the department will pay $38,106 per month, or
$457,000 per year, more in per diem costs to transfer just 48 women from Grants to Camino
Nuevo. Moving the women will require the department to pay a $40 per diem at Camino Nuevo
as opposed to a $13.90 per diem at NMWCF.
Table 9. Women’s Facilities Population and Per diem Rates
March 2007

NMWCF

Camino Nuevo

March 2007 Actual
Inmate Population
322
193
54

Number of Inmates

Per diem

1-322
323-516
>516

$62.06
53.83
$13.90

48
4
0
0

1-48
49-96
97-144
145-192

$163
$40
$19
$17
Source: NMCD

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Better management of savings created by staff vacancies at private facilities. As noted above,
New Mexico pays for a relatively expensive staffing pattern for its private facilities, particularly
for inmate programming. However, the facilities often run high vacancy rates which do not
benefit the department programmatically or financially. For example, as of April 2007 LCCF
reported a 37 percent vacancy rate for security posts. The department is paying for a full
complement of staff and the services that they are supposed to deliver. The contracts do not
anticipate routine staff vacancy savings common to any organization, including state
government, and as a result the private operator, not the state, benefits financially.
The department’s contracts provide penalties for any unfilled positions after 30 days, not just
mandatory security positions. This contract provision is discretionary, rarely enforced and
applies to individual positions. For example, GCCF had 17 vacant security positions for more
than 30 days in June 2006. But the department did not enforce any penalties. In addition, the
private operator could meet the 30-day requirement through changing staff assignments, but due
to high turnover of staff still maintain unsatisfactory vacancy rates. If the facilities’ operational
quality is not hampered due to high vacancy rates, then the department may be paying for staff
that isn’t needed.
Require private prisons to justify annual price increases based on performance. The department
misses an opportunity to use positive financial rewards based on performance. The department’s
private prisons are long-term agreements with little practical opportunity for changing vendors
for non-performance. One option for extracting better performance could be by only giving
price increases to facilities that demonstrate superior performance. This approach would assure
that only high-performing facilities receive price increases and serve as an incentive to others.
The base per diem for the Clayton prison appears higher than its comparison facility in
Guadalupe County. As a result, Clayton’s operating cost is $2.5 million higher than GCCF
based on housing 540 inmates. According to GEO, the Clayton operating costs are based on
costs at GCCF. However, GCCF per diem includes debt service costs. The department did not
account for this difference by reducing the GCCF per diem to near actual operating costs in order
to compare the two facilities’ operational per diems. Clayton per diem excludes additional debt
service cost included in GCCF per diem.

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Chart 9. Per Diem Rate and
Debt Service Rate Com parison

$100
$80
$60
$40
$20
$0
Operating
Cost

Debt
Service

GCCF

Total

Clayton
Source: NM CD

Recommendations. The department should seek to modify its agreements with counties and
private contractors to do the following.
Restructure per diems to take advantage of economies of scale and separate facility use fees. At
a minimum, the agreements for LCCF and GCCF should be structured using a three tier per diem
structure similar to Clayton. This would include a base per diem (existing per diem less
recalculated debt service), incremental per diem (about 30 percent of base per diem) and a
separate debt service fee. In recalculating the debt service fee the department should reduce past
price increases. Work with private vendor to include total financing costs in the facility debt fee.
We conservatively estimate the department could save about $4.9 million per year and $49
million over the next 10 years by only paying the variable cost, such as food and clothing, of
housing inmates above 90 percent capacity and not overpaying for debt service. Separating
construction costs will allow the department to identify how much the per diem should drop in
ten to twelve years as the facilities are paid off and not provide inflation adjusted price increases
on fixed costs.
Do not apply price increases to the separate debt service fee. This change could save an
estimated $11 million over the next ten years. Maintenance costs are already included in the
base operating per diem.
The per diem structure for operational agreements for the women’s facilities in Grants
(NMWCF) and Camino Nuevo in Albuquerque needs restructuring as well to, at a minimum,
allow the department to transfer another 40-50 inmates at no extra cost. This could help the
department avoid an estimated $457,000 per year as Camino’s population ramps up.
At a minimum, withhold five percent of the total estimated contract amount to better manage
savings created by staff vacancies at private facilities. Set vacancy rate target at a reasonable
level (10 percent) for contractor to earn the five percent back. Modify contracts to automatically
deduct the amount for at least unfilled security positions after 30 days. Require contractors to
provide detailed invoices. For example, invoices should include the current month’s number of
education classes conducted, and number of classes cancelled and the reasons for cancellation.
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Require private prisons to justify annual price increases based on meeting performance
measures. The department should also measure public facilities performance on an expanded
number of measures listed throughout this report.
Reevaluate the base per diem costs for the Clayton facility and consider bringing it more line
with GCCF.
Require contractors to submit prior year actual expenditures and financial audits, a balance sheet,
statement of income and expenditures, and statement of cash flow for each facility.
Require LCCF to refund $456,239.88 to the state for non-performance of the sex offender
treatment program.

NEW MEXICO’S APPROACH TO PRISON PLANNING AND CONSTRUCTION IS
NOT IN THE TAXPAYERS’ BEST INTEREST.
The department projects its inmate population will increase 37 percent by 2016, requiring
bed space for an estimated 9,365 inmates. Over the past 28 years, the department’s budget
has increased over 1,495 percent from $20 million in 1980 to $299 million in 2008. The number
of inmates has increased 442 percent from 1980 through March 2007.
According to the Legislative Council Service, “sentencing policy changes in the 1980s and
1990s, which were gaining wide support both in New Mexico and nationally, contributed to
faster-growing prison populations. The changes included mandatory prison sentences for
selected crimes (including drug offenses), longer sentences for some offenses and limitations on
the early release of inmates.” For example, current truth in sentencing laws require New Mexico
inmates to serve 75-80 percent of their sentences as opposed to the former good time provisions
that allowed inmates to serve 55-60 percent of sentences, according to the department.

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10,000

Chart 10. NMCD Inmate Population Growth
1978 - 2017

9,000
8,000
7,000
6,000
5,000
4,000
3,000

Actual

Projected

2,000
1,000

19
78
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
20
08
20
10
20
12
20
14
20
16

0

Source: NM CD

Historically, the department’s population projections have been generally accurate. Projections
are based on the current law at the time of the projection. Changes in laws, policies and
sentencing practices of judges, among others, can impact the accuracy of long-term projections.
However, ten-year projections are useful for long-term planning and assessing the costs of
incarceration. Long-term planning helps refocus the department from the yearly fluctuations that
can occur in prison populations and evaluate the need for future prison space.
The department regularly monitors JFA & Associates’ population projections. The department
considers +/- 3 percent as an accurate projection and tracks this data monthly. The projections
are generally accurate, running about 2 percent higher than actual inmate population over a 12
month period. However, as of March 2007 the projection was eight percent higher than the
actual population. In comparison, a year ago the department was facing overcrowding in its
prisons and quickly running out of bed space.
Despite the additional prisons in Springer, Clayton and Albuquerque, the department may
require additional bed space within two to four years. The department has or will increase its
bed space capacity to 7,755 by 2008 by adding beds at Springer and Clayton. According to JFA
the department will run out of capacity in 2009, however internally the department projects it
will exceed capacity in 2011.
Rapid deterioration and an inefficient design make New Mexico’s public prison facilities
increasingly expensive to operate. Two key factors contribute to inefficient prison designs of
New Mexico’s public facilities. The 1980 riot at PNM demonstrated that inmates could quickly
overtake an entire facility. According to the department, the state’s response to increased need
for inmate control was to design smaller 48-cell housings units spread across a campus separate
from programming and central control complexes. The Duran consent decree required the state
to house medium security prisoners, which makes up the bulk of inmates, in single-man cells. At
the time these designs and agreements may have made sense, but over time have proved
extremely costly. For example, one public correctional officer oversees each 48-cell housing
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unit control center versus one private correctional officer that can oversee 160 inmates due to
facility design.
Public prisons also house high security inmates and have become increasingly specialized. For
example, CNMCF includes the mental health and long-term care treatment units. High security
and specialized units are more staff intensive or require addition higher cost professional
personnel, which contributes to higher operational costs.
The department may require an estimated $100 million in capital outlay funding to repair public
facilities statewide over the next five years. The Property Control Division (PCD) at the General
Services Department (GSD) provides repair and replacement estimates for state owned facilities.
The estimates are based on the facility condition index, which reflects the costs of repairing a
building divided by the cost of replacement. Buildings with an index rating of 60 – 70 percent
should be considered for replacement, rather than repair. Most of the assessed costs relate to
mechanical, electrical, plumbing, floors, walls, doors, and site renovations. Few of the
department’s buildings require full replacement today; however, without repair many may
require replacement sooner than later.
Twenty housing units, 960 cells, at SNMCF and CNMCF need about $26.8 million in repairs to
extend their usefulness. These housing units were built in 1983 and 1981, respectively, and need
repairs to plumbing, heating and cooling systems, new roofs and some electrical. Plumbing has
never been upgraded and is past its 20-year life cycle at each facility. Ductwork at CNMCF is
crushed due to foundation problems and the SNMCF cooling system fails during the hot Las
Cruces summer months. Maintaining decent living conditions in prison housing units helps
reduce unrest among inmates, according to staff.
WCNMF has some of the most serious facility problems, based on LFC staff observations and
interviews. One housing unit is sinking and separating from an attached structure, and the
plumbing across the facility is corroding as quickly as it is repaired due to the hard water in
Grants. Modular units housing low-security inmates appear in disrepair. PCD is currently in the
process of updating the estimated repair/replacement costs for WNMCF – meaning the current
repairs totaling $19.3 million may increase significantly in the near future.
Continued increases in inmate population mean that New Mexico cannot afford to reduce the life
of existing prison buildings due to deferred maintenance. Many state prison buildings will reach
their estimated life cycle during the next ten years, requiring decisions on whether to continue
using the buildings or replacing them. Entire complexes may not require replacement, but
housing units constructed in the early 1980s may need either continued upgrades or replacement.
Significant capital investments in these housing units may not make fiscal sense because of the
higher costs to staff and operate these small units. For example, in FY05 WNMCF was the
second most expensive facility to house an inmate at $102 per day.
New Mexico’s use of county jail statutes as the basis for building private state prisons
results in the state paying for a prison it will never own. The effect of decisions to
alternatively finance prison construction and the 1989 Montano Supreme Court decision barring
lease-purchase agreements will result in the department paying for three prisons it will never
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own: Clayton, LCCF and GCCF. The department sold its equity interest in the NMWCF in 1999
for $3.5 million and does not fully use county jail space in Torrance and Santa Fe.
Since the mid-1990s, New Mexico has expanded the financing of prison construction from using
traditional public capital outlay funding to private or local financing. This approach shifts
prison construction costs to the department’s operational budget through higher private prison
per diems. In many cases, these costs are even hidden within the per diem as demonstrated in
other sections of this report. The shift in costs results in higher department operational budgets.
The NMWCF was the first privately financed facility in 1988. This practice became more
widely accepted as the state needed more prison space.
The 1989 Montano Supreme Court decision barred the state from entering into certain leasepurchase agreements because they violated the constitution’s restrictions on state debt.
Essentially the decision said lease-purchase arrangements, which allowed government entities to
possess assets after making specified lease payments, constituted debt that requires voter
approval. The practical effect of the decision on the department was that it would pay for a
private or locally financed prison facility through higher per diems but never have an equity
interest or clear ownership right after the facility debt was paid off.
Not using traditional state capital outlay financing for prison construction results in higher longterm costs for the state taxpayer. This alternative financing approach has freed-up the state’s
bonding capacity and one-time funding for use on public capital outlay projects other than prison
construction. However, fully financing a prison costs more than if the state used one-time capital
outlay funds to pay cash or partially pay for construction. For example, the prison in Clayton
will cost about $61 million to construct. However, the department will pay $132 million over
twenty years for construction and financing charges through higher per diems rates.
Construction of prisons in Lea and Guadalupe counties were financed by the private contractor.
The state should be able to secure tax-exempt financing at cheaper prices than private prison
operators, which would have significantly reduced borrowing costs. The private prison’s higher
borrowing or financing charges are presumably built into New Mexico’s higher per diem rates by
the department. The state has no legal ownership interest in these facilities even though in
practice it will pay the full cost for construction.
The department did not anticipate the opportunity to use a lease-purchase agreement for the
Clayton prison that may prove costly. In 2005, the Legislature passed HJR 9 that proposed a
constitutional amendment allowing state agencies to enter into lease-purchase arrangements
originally banned by the Montano decision. The agreement with Clayton did not anticipate
possible voter approval of the constitutional amendment, which would provide the opportunity
for the department to own the Clayton facility after 20 years. The department finalized the
agreement in September and the voters approved the amendment in November 2006. The state
has the option to purchase the Clayton facility, but without consideration of intervening lease
payments. As a result, Committee staff considers the contract’s purchase option clause to mean
that the state would have to purchase the prison at market value because the state and Clayton
would negotiate a price or the state would have to match a third-party price offer.

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State use of existing local jail statutes also allows the department to bypass an important
cost containment provision provided by the Procurement Code. As a result, the department
does not benefit from the competitive requirements that force down contract prices. Because the
local jails (prisons) are both owned and operated by the same company, the department is forced
to negotiate contract prices in a non-competitive and monopolistic environment.
Local government contracts with a private independent contractor for the operation, or provision
and operation, of a jail are exempt from the Procurement Code (Section 13-1-98 (M) NMSA
1978). A 1987 Attorney General opinion concluded that the design and construction of jails
were also exempt from the Procurement Code. The department has statutory authority to
contract with county jails to house state inmates (Section 31-20-2(G) NMSA 1978). Presumably
this authority was granted to ease overcrowding at state prisons and does not contemplate the
department using an entire jail for state inmates. Since contracts with counties are considered
intergovernmental agreements they too are not subject to the Procurement Code. The Committee
and other lawmakers questioned this tactic, but according a letter from then-Attorney General
Madrid’s office in 2005 the practice is perfectly legal under state law.
Contracting for both the use and operation of prison facilities puts the state at a poor negotiating
position to obtain low cost, high quality prison services. Using an owner-operator contract
model outside a competitive process further reduces the advantages of privatization. These
advantages include demonstrated lower prices and higher quality normally produced through
competition, ability to change vendors and the flexibility offered by reducing long-term
obligations.
The department contracts for almost half of its total bed space and will continue to need
contracted bed space in the foreseeable future. Three department agreements, in particular, put
the state in a less-than-ideal negotiation position for prison services because the private provider
both owns and operates the facility. These include LCCF (1,250 beds), GCCF (600 beds) and
NMWCF (600 beds). The department has few practical alternatives for housing this many
inmates if it cannot afford, or is unhappy, with the prison contractors’ service. Prisons are
expensive to build and operate; resulting in a very tight marketplace and few options in terms of
alternative prisons to place inmates.
Executive policy combined with the department’s lack of active long-term planning to
accommodate inmate growth has led to a disjointed and costly approach to acquire needed
bed space. The department lacks concrete policies to guide site selection and decision making
for adding bed space. The department has attempted to implement the Governor’s policy of not
using state capital outlay funds for building prisons. From FY03 to FY06, the department
experienced a nearly 15 percent population growth (630 inmates) and crowded prisons. The
department developed short-term goals to accommodate a growing prison population that put the
department in a reactive, rather than proactive, position to acquire bed space at a low cost.
Despite the no new prisons policy, the administration and department agreed to finance the cost
of a new prison in the town of Clayton, as discussed above, and take over two existing juvenile
facilities vacated by the Children, Youth and Families Department (CYFD). The facilities in
Clayton, Springer and Albuquerque will be some of the most expensive to operate in the state.
This approach lacks consideration of the following.
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•

•

Short and long-term cost. The department avoided the need for capital outlay funding
to construct facilities by taking over Springer, Camino Nuevo and contracting with
Clayton but will pay higher long-term costs as a result. For example, Springer will cost
an estimated $120 per day for 260 low-security inmates. This per-inmate cost is similar
or higher than what the department must incur to house maximum security inmates. As
pointed out above, the state will pay $132 million over twenty years for a $61 million
dollar facility in Clayton that the state will never own.
Impact on operations. Contemporary prison operations rely more heavily on licensed
professionals for medical, mental health, education and substance abuse services.
However, the department’s ability to hire professional staff in remote and rural areas may
prove difficult. In addition, adding more facilities in different areas of the state reduces
economies of scale that can be achieved from adding bed space to existing facilities and
increases other costs such as construction and inmate transportation.

Current law limits the department’s flexibility to add bed space or replace existing prisons
at a more affordable price. State law allows the department to contract for the operation of a
prison with a private vendor through a competitive process (Section 33-1-17 NMSA 1978).
However, the law restricts department flexibility by only authorizing private prisons in certain
counties or only for women’s facilities. Without support for public prison construction, the
department is left with using intergovernmental agreements with counties to house state inmates
to meet space needs. These agreements lack controls needed to ensure lower-cost services
because they are non-competitive.
The law does not require the department to ensure that private prison operations will cost less
than if the department operated the same facility. According to a Moss Adams study, GEO's
proposed wage costs for the Clayton facility were 16 percent less than the average wages for
similar positions based on U.S. Bureau of Labor Statistics for New Mexico. However, compared
with state employee wages, GEO's costs were only 1.5 percent less.
Other states statutorily require that private prisons cost less than if the state were to operate the
facility. This approach ensures the state receives savings associated with privatizing prison
operations.
Other alternatives exist to finance prison construction that would be more beneficial to the
department and state taxpayer. The state has many options to finance prison construction
ranging from purely state capital outlay to wholly privately financed prisons. The least
expensive options require use of the state’s general obligation or severance tax bond capacity or
one-time general revenue funding. The next best options include the following.
• Dedicate income from the permanent land grant fund to finance prison construction as
authorized by current state law (Section 33-1-18 NMSA 1978). Currently, the Legislature
appropriates land income for the penitentiary of New Mexico to the department for
operational expenses. This income could be used to pay debt service on bonds issued for
the department by the Board of Finance. Diverting this revenue to the prison fund would
require a replacement or reduction by the same amount of general fund revenue for the
department’s operating budget. Adding or replacing prisons will require a net increase to
the state no matter what. The department would need additional flexibility to procure a
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•

•

prison because current law restricts the use of the prison fund to certain counties or type
of building.
Authorize the New Mexico Finance Authority to issue revenue bonds for prison
construction and use lease payments from the department to repay the bonds. The state
could designate GSD or create a public corporation as the owner of the facility. This
option would mirror the arrangement currently used in the Clayton agreement, but
ownership of the facility would be in the hands of a state, not a local or private, entity.
This option better protects the state’s long-term financial interests.
Clarify state law to authorize the department to procure privately financed prisons
through a lease-purchase agreement. In 2007, the enactment of House Bill 1022
provided an enabling statute and criteria for lease-purchase financing of state buildings,
including requiring legislative approval of any agreements. For the department, the
statute should protect the state’s interests by prohibiting a private owner-operator model.
Current agreements would have to be exempt. This approach would also allow the
department to decide whether to procure a private vendor to operate the facility or
whether it could operate the facility at a similar or lower price. In addition, the approach
would not lock the department into long-term operational contracts that limit its
negotiating power.

Recommendations. Committee staff proposes the following statutory changes.
•

•

•
•

Require the department to develop and implement a 10-year facility strategic plan. At a
minimum, the plan should forecast projected growth in the inmate population; provide
information, in coordination with the New Mexico Sentencing Commission, concerning
impacts on the inmate population caused by changes in sentencing policies and law
enforcement policies; prioritize projects to repair or replace existing correctional
facilities, including analyzing the need for future construction of additional correctional
facilities, and estimated costs; if necessary, prepare proposed legislation to further the
implementation of cost-effective correctional facilities; and ensure recommendations
consider public safety concerns. The department should be required to update the plan
every two years and submit the plan, including any legislative proposals, to the interim
Courts, Corrections and Justice Committee; the Legislative Finance Committee; and the
Department of Finance and Administration no later than November 1 of each even
numbered year. The plan should form the basis for capital outlay spending.
Amend Section 33-1-17 NMSA 1978 to remove restrictions on the location or type of
correctional facility for which the department may award a contract. Amend the section
by including provisions to prohibit the department from entering into agreements with an
operator who also owns the facility and requiring the department to demonstrate that
operation of the facility would cost, at minimum, 10 percent less than if the department
operated the facility.
Amend Section 33-1-18 NMSA 1978 to authorize establishment of only the New Mexico
prison fund by repealing references to the corrections department building fund and
Guadalupe county prison fund. These other funds are no longer necessary.
Amend Section 33-1-19 NMSA 1978 to remove restrictions on the location or type of
correctional facility for which the department may use proceeds from the New Mexico
prison fund and remove authority to use the fund proceeds for operating lease
agreements.

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•

Authorize the department to procure private or locally financed correctional facilities by
entering into lease-purchase agreements, subject to the provisions of Laws 2007, Chapter
184 (H.B. 1022).

Throughout the interim, legislative committees could explore other alternatives for prison
financing, including whether to grant specific revenue bond authority to the New Mexico
Finance Authority for prisons or creating a public corporation to own any financed correctional
facilities.
The department should modify the Clayton agreement by adding a lease-purchase clause to
ensure the state, if it chooses, will own the facility after twenty years or may purchase the facility
at any time. The purchase price should take into consideration past lease payments.
THE DEPARTMENT NEEDS BETTER OVERSIGHT TO CONTAIN MEDICAL COSTS
AND ENSURE THE PROVISION OF ADAQUATE CARE.
The quality of inmate medical care varies by facility, however, the department has failed to
systematically ensure Wexford delivers adequate medical services. Committee staff
contracted with two nationally renowned medical experts, Dr Steven Spencer and Dr. Jaye Anno
(LFC medical experts), to conduct an in-depth evaluation of the department’s medical services.
Their full report is included in Appendix B and their major findings are incorporated below.
Overall, LFC-contracted medical experts found that health care staff at the facilities includes
many qualified professionals, but system-wide the quality of care provided is inadequate. At the
time of this report, the department terminated its contract with Wexford and was in the process
of soliciting bids for a new medical contract.
Improved monitoring of inmate’s access to care and addressing complaints is needed.
Wexford’s insufficient record-keeping, the lack of meaningful and consistent reports and poor
communication between Wexford and the department has limited oversight of access to care,
particularly for off-site specialty care. LFC medical experts could not conclude whether inmates
received timely off-site care because of a lack of information on inmates’ cases where a final
decision was deferred to a later date. For example at LCCF, of the 40 cases presented between
November 2006 and January 2007, only 15 (37 percent) were approved by Wexford. However,
without a department physician reviewing the cases that were deferred, it is impossible to know
whether those decisions were medically appropriate.
LFC medical experts questioned the effectiveness of the grievance system. Many facilities
reviewed had very few inmate grievances, in some cases representing only one percent or less of
a facility’s inmate population. The department does not track or analyze informal complaints
made at the unit level regarding medical care. This approach could be more illustrative of the
effectiveness or problems with the medical system. For example, inmates may complain at high
rates over access to care issues but not file formal grievances, or units may effectively remedy
the problem and thus avoid a formal grievance.
Corrections Department oversight and the quality improvement program have failed to identify
problems in a timely fashion. The department’s lack of a medical director during part of 2006
greatly compromised its oversight responsibility for quality of care. For example, 14 inmates
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died in department facilities in 2006, but the department had not completed the necessary
reviews of these deaths as of April 2007. In addition, Wexford did not complete its portion of
these mortality reviews timely. As a result, the department does not know whether lack of
adequate care lead to these deaths.
The department relies too heavily on Wexford self-monitoring and other external accrediting
agencies to assess the quality of care delivered to inmates. Also, the department and Wexford
lack an adequate continuous quality improvement program to ensure effective and efficient
inmate medical care, according to LFC medical experts.
The geriatric housing unit at the Central New Mexico Correctional Facility is countertherapeutic, according to LFC medical experts. There is a small geriatric population at CNMCF
housed in three modular units, or trailers, with a total of 42 beds. The modular units need repairs
and other modifications to improve living conditions, according to LFC medical experts. The
quarters are cramped and there is barely enough room for wheelchairs to pass down the aisle.
The floors are rotting and some of the plumbing does not work.
Wexford’s chronic illness program fails to meet national standards, resulting in poor medical
outcomes for inmates according to LFC medical experts. LFC medical experts reviewed a
sample of records for inmates receiving care for chronic conditions such as diabetes, asthma, and
hypertension. Evidence revealed that Wexford staff failed to follow nationally accepted
guidelines for providing care in numerous cases and found examples of erroneous diagnosis of
inmate’s health conditions. Inmate health outcomes suffered as a result. Overall, the chronic
care program has poor record keeping and uses inadequate medical forms. The department does
not gather performance information system-wide on adherence to national treatment guidelines.
The department has not effectively monitored the cost of medical services or enforced key
contract provisions such as staffing requirements. Contract costs for medical services have
increased almost 59 percent since FY03 and more than doubled in the past ten years. The
department sought to contain these increases through the state’s SaveSmart initiative when it
contracted with Wexford. A 2005 Committee performance audit of SaveSmart indicated the
department estimated saving about $800 thousand. In FY07, the department expects to pay
about $34 million for medical services. Chart 11 shows the cost of the Wexford contract and
inmates.

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Chart 11. Medical Costs
FY05-FY07
10,000

$35,000

9,500
9,000

$30,000

8,500
8,000

$25,000

7,500
7,000

$20,000

6,500
6,000

$15,000

5,500
$10,000
FY05
FY06
Medical Costs

5,000
FY07
Inmates
Source: NM CD

The contract with Wexford provides for an automatic price increase, regardless of performance
or justification for increased medical costs. The Wexford contract lacks specific performance
measures, such as timely access to offsite care and adherence to clinical treatment guidelines, to
assess the results and outcomes of services delivered.
The department does not regularly obtain information about Wexford medical spending to
ensure the adequacy of the contract amount and prevent inappropriate cost-containment that
could impact inmate care. The department lacks sufficient information showing the health status
of its inmate population and use of services needed to approve an effective staffing pattern or
ensure an appropriate contract price for medical services. Some of this information is
maintained by Wexford at each site per department policy, but the department’s central office
staff has not received system-wide reports or reports from individual facilities on a routine basis.
During this review, the department’s central office began compiling monthly statistics regarding
use of health services.
The contract requires that Wexford will assume full risk and liability for cost overruns, which
provides a strong incentive for the company to contain costs. However, the department lacks
needed oversight mechanisms to ensure Wexford does not inappropriately cut or restrain care.
These oversight mechanisms include tracking, timely access to expensive treatments – which the
department has not done – and treatments that on aggregate are costly, such as prescription
drugs. The department has not routinely received this type of information, even though the
contract provides for it. During this review the department did obtain some aggregate data.
Other systems, Medicaid for example, require limits on the amount of funds that managed care
companies can use for administration, overhead and profit. The department’s contract does not
require such a spending test.
Inadequate or nonexistent medical staffing limits inmates’ access to care. The department has
struggled to enforce staffing requirements and lacks information needed to easily monitor
vacancies. Without aggressive monitoring and enforcement of staffing requirements, Wexford
can generate vacancy savings and inmates do not receive appropriate medical care. The
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department has imposed about $90 thousand in financial penalties for staffing vacancies over the
term of the contract.
According to LFC medical experts, the present contract does not provide adequate authorized
staffing positions or hours of services. The contract includes insufficient physician staffing at
LCCF and WNMCF, insufficient dental staffing at LCCF, PNM, NMWCF and CNMCF,
insufficient optometry staffing at CNMCF and PNM, insufficient clerical staffing at all facilities,
and insufficient nursing (particularly RN) at all facilities.
Wexford’s vacancy rates and turnover have compounded the inadequacy of authorized positions.
For example, review of the physician staffing at LCCF shows that a physician was on site 21
days in September, 22 days in October, and 20 days in November. However, the physician
resigned in December. After the physician left, inmates only had access to a doctor 16 days in
December and seven days in January.
Some facilities have serious backlogs for access to dental care. A dentist was on site at LCCF
five days in September, nine in October, six in November, eight in December, and only three in
January. PNM had 89 inmates on dental wait lists and the NMWCF had approximately 130,
down from over 200 last year. At one facility our medical experts found that inmates no longer
submit any sick call requests for dental care unless they have a very serious problem or a
toothache, since they know that the chances are they will not be seen for many months.
The department has allowed Wexford to by-pass using local medical providers in some areas,
such as Hobbs, which results in increased security and transportation costs for off-site care.
The medical contract requires Wexford to consolidate the scheduling of appointments and
services for inmates with community physicians, hospitals and other providers and services to
minimize the impact upon security staff and available vehicles. However, Wexford uses a
provider in Albuquerque for its off-site consultations, which is about a six-hour drive from
Hobbs. This not only places a burden on security staff and vehicles, but it serves as a
disincentive for inmates to complete their appointments, because they have to go to Albuquerque
and back the same day.
The department lacks adequate staff to oversee a complex and expensive medical system that
serves over 6,500 inmates across ten facilities. Currently, the department has an acting Bureau
Chief, a vacant quality management position, a 30-hour per week clinical psychiatrist, a statewide director of nursing, a state medical records manager, and an administrative assistant. The
acting Bureau Chief held the quality management position until recently. The department plans
to hire a clinical physician sometime soon.
LFC medical experts report that the Bureau of Health Services staff audits the Wexford facilities
at least annually. However, their auditing tools are designed more to determine the extent of the
facilities’ compliance with national standards rather than compliance with specific terms of
Wexford’s contract. The current contract provides for numerous financial penalties to be
assessed if Wexford violates specific terms. However, these areas are not all regularly monitored
by the Bureau of Health Services. On the medical side, Wexford has refused to provide staffing
vacancies until recently, according to the acting Bureau Chief. The last two quarters, Wexford
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has reported aggregate staffing levels, but not site-specific information.
requirement of the new contract.

This should be a

Recommendations. Ensure the department’s new medical contract does the following.
• Limit annual price increases to no more than the medical service CPI for western states
based on meeting certain performance targets. These performance measures and targets
should include, at a minimum, those related to timely access to care; quality of care, such
as adherence to clinical treatment guidelines; low staff turnover, vacancies and use of
contract nurses; and meeting reporting requirements.
• Withhold no less than five percent of the total estimated contract amount as a
performance incentive for maintaining low vacancy rates. Ensure the next medical
contract includes automatic financial penalties for excessive staff vacancies, particularly
for critical professions such as physicians and dentists.
• Continue to use an “at-risk” contract approach, but require a direct services spending test
of no less than 90 percent of total contract amount. This will limit indirect spending on
administration, corporate overhead and excess revenue.
• Require the medical vendor to provide monthly reports on medical spending by defined
expense categories and staff vacancies by type of staff. These should be submitted with
invoices.
Conduct a cost-benefit analysis before allowing vendor to centralize off-site medical care by
factoring the costs of security and transportation prior to approving the use of non-local off-site
medical service.
Request a health services monitor position in the FY09 budget request. The monitor should be
responsible for, at a minimum, day-to-day contract management, including ensuring financial,
performance and clinical information is gathered in a timely and useful format.
Fill the department’s medical director position with a permanent physician as soon as possible.
Begin addressing deficiencies in the CNMCF Geriatric housing unit immediately and develop a
long-term housing plan for these inmates that meet their therapeutic and medical needs.
Track both informal medical complaints and formal grievances in a format that allows
comparative analysis of nature of complaints, by facility and system-wide. The format should
also compare previous quarters, months, years or annual targets as determined by the department.
Implement remaining recommendations from LFC medical experts included in Appendix B.
MORE INFORMATION IS NEEDED TO DETERMINE BOTH THE QUALITY AND
EFFECTIVENESS OF THE DEPARTMENT’S INPATIENT ADDICTIONS SERVICES.
The department allocates about 700 beds to therapeutic communities (TC), which serve as
residential substance abuse rehabilitation programs. The department has a goal of ensuring
90 percent of its TC bed space is used by active TC participants. Contract beds (CB) account for
about 12 percent of total bed capacity in TC units.
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According to the department, therapeutic communities (TCs) are voluntary one year-long
residential treatment programs for inmates with drug or alcohol addictions. TC units exist in all
department public and private facilities, except Santa Fe County Detention Facility and the
Torrance County Detention Facility. TCs generally are supposed to operate in separate housing
units apart from general population inmates and provide a daily regimen of substance abuse and
criminal behavior therapy within a structured living environment. Department policy encourages
TCs to operate as a “self sustaining sub-culture responsible for its own administration in order to
facilitate desirable pro-social functioning” (CD-185200 (I)). The program is divided into four
separate stages: I – entry into TC; II – Skills Development; III – Re-entry planning; and IV –
Relapse Prevention.
All inmates are given the opportunity to participate in addictions services. However, TCs target
inmates with diagnosed substance addictions, inmates with two years or less left on their
sentences and inmates dually diagnosed with a mental and substance abuse disorder. Inmates
also must agree to random drug urinalysis testing.
New Mexico’s prison population continues to increase and most of the state’s inmates have a
substance abuse problem. According to the department about 60-75 percent of its inmate
population meets the criteria for substance dependence and about 85 percent have a history of
substance abuse. Research indicates a strong link between substance abuse and criminal
behavior. Nationally, 51 percent of surveyed inmates reported the use of alcohol or drugs while
committing their offense and “while only 20 percent of state prisoners are drug offenders, 57
percent were using drugs in the month before their offense, and 37 percent were drinking at the
time of their offense,” according to the 1997 Survey of Inmates in State and Federal Correctional
Facilities.
National evaluations demonstrate that in-prison therapeutic communities can significantly
reduce recidivism based on meeting certain program standards. Model TC programs can
significantly reduce recidivism, according to research summarized by the Institute of Behavioral
Research at Texas Christian University and the Washington State Institute for Public Policy. On
average, TC programs can reduce recidivism by 5.3 to 6.9 percent. Effective TC programs
operate intensively for six to 12 months in a segregated housing unit; engage offenders in
transitional and aftercare services; target certain high-problem offenders and use risk
assessments to screen inappropriate placements; and use induction strategies to raise inmates’
engagement in treatment.
The department’s TC program meets many, but not all, national standards, but the lack of
coordinated aftercare programs and other deficiencies may severely limit its overall
effectiveness. The New Mexico TC program lacks the following components.
Lack of totally separate housing unit. About 12 percent of the department’s TC bed space is
allocated for non-TC inmates. As of March 2007, 82 percent of available bed space was used by
TC participants, with the remaining filled with non-TC inmates or unfilled. The department
does not feel this arrangement violates program standards as non-TC inmates must agree to
“random urinalysis testing, participate in dorm meetings and agree to support the goals of
drug/alcohol free living.”
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However, a 2002 evaluation of the TC unit at SNMCF noted that the program conditions were
violated due to housing non-TC inmates in the same housing unit. The department still faces this
problem due to the design of many New Mexico’s minimum security Level II prisons resulting
in lack of totally separate housing arrangements. For example, only 40 percent of inmates living
in PNM and CNMCF’s Level II units are actively participating in the TC program and about 50
percent are participants at SNMCF and WNMCF.
Chart 12. Theraputic Community - Bed
Space Use - March 2007
Pecent of Beds Used by Active TC

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
P
CN NM
M
CN CF
M II
C
SN F
M III
SN CF
M II
C
RC F II
C I
RC T
C C
D
W W
NM I
C
G F
CC
F
LC
C
N
F
M MW
ar
c h CF
To
ta
l

0%

Source: NM CD

Mixing treatment methodology. The TC program primarily uses a mix of TC programming,
cogitative-behavior therapy, and self-help 12-step groups. A federal evaluation of TC programs
expressed concern over the mixing of different treatment methods – therapeutic community, 12step program, and cognitive-behavioral therapy. The evaluation noted that “combination
treatments have not been fully evaluated and that many combinations may result in watereddown components, leading to less effective treatment.” These treatment approaches are based on
different theories and practices. For example, 12-step programs are spiritually-based and rely on
non-professionals and recovering addicts for service delivery and support, which is different
from professional therapy.
Lack of routinely paroling/discharging inmates near or at TC graduation. The department does
not track the percentage of TC participants that parole/discharge at or near their graduation date.
Department policy sets a guideline that inmates must be within two years of release to gain
admittance to a TC program. However, many inmates begin treatment in Level III prisons.
Starting TC at higher security levels may result in many inmates participating in TC who may
not be within two years of release, according to department staff.
Transfers among facilities impact inmates’ therapeutic progress and may reduce the TC
program’s overall effectiveness. The department has allocated about 60 percent of its overall TC
and contract bed space to Level III prisons. LCCF accounts for 301 beds, or 37 percent of all TC
and contract bed space system-wide. As many of these inmates participate in TC programming,
their security level may be lowered for good behavior resulting in a move to a different facility.
In addition, the percentage of graduates and the number who complete the full TC program at
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one location are severely diminished. The Addictions Bureau “views these transfers as having a
critical impact on recidivism rates.” However, the department has not studied how many inmates
transfer, and how often, while participating TC programming to determine the extent of the
problem. TC continuity of care could be compromised due to transfers either because an inmate
is transferred to a unit without a TC or will have to integrate into a different group therapy
arrangement.
Lack of formal aftercare services. Well-designed programs include comprehensive reentry and
aftercare services, from pre-release planning to strong linkages with community substance abuse
treatment providers and other supportive services. A federal RSAT evaluation found that strong
aftercare programs to help prisoners transition back into their communities drug-free were
lacking nationwide, partly due to lack of funding. According to the evaluators, outcome studies
show that aftercare programs further reduce recidivism and are critical for overall program
effectiveness. For example, an evaluation of California’s Amity program showed that offenders
who completed the program but did not participate in aftercare returned to prison at higher rates
than prisoners that did not participate in Amity altogether.

Percent New Arrests

Chart 13. Delaware/Crest Program
3-Year Re-arrest Rates
80%
70%
60%
50%
40%
30%

72%
71%
45%

20%
10%
0%

31%

No
Treatment
(n=210)

TC Dropout
(n=109)

TC, but no
Aftercare
(n=101)

TC +
Aftercare
(n=69)

Percent Return-to-Custody

Source: TCU - 1999

Chart 14. California 3-Year Return-toCustody Rates
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

75%

82%

79%

27%

No
Treatment
(n=189)

TC Dropout
(n=73)

TC, but no
Aftercare
(n=154)

TC +
Aftercare
(n=162)
Source: TCU, 1999

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The department has not regularly evaluated the quality of services delivered, and its recent
attempt at quality assurance needs improvements to make reports more useful. The
department has participated in one in-depth evaluation of a TC program at SNMCF in 2002. The
evaluation assessed the program’s compliance with national standards, of which there were
deficiencies that have not been resolved and are discussed below, and of the quality of
programming. In 2006, the Addictions Services Bureau began conducting site visits as part of a
developing continuous quality improvement (CQI) process. The CQI audit primarily consists of
a file/document compliance review but does have limited performance (timely treatment plans)
and quality (treatment goals relate to problems to be addressed) criteria. The onsite review also
includes qualitative information obtained from inmate participants. The CQI audit tool and
report format could be improved through the following.
• Data Accuracy. The CQI process does not assess data accuracy. The bureau needs to use
data and performance information to evaluate program success, manage the program and
improve performance. To accomplish these tasks management has to rely on the data
produced by individual programs at each facility. The CQI process could help ensure
data received by central office either through monthly reports or CMIS is accurate.
• CQI Report Format. The report is presented in a narrative format that does not allow
management outside of the bureau to easily understand or obtain the results of CQI audit
scores. The CQI audit results in an aggregate compliance score as well as compliance
scores for each of the major areas reviewed, including admissions, file completeness,
urinalysis, treatment plans and discharge plans.
• Performance Information. CQI audits do test two items that could be used to assess
program performance: timely treatment plans and percent of TC participants with a
substance abuse diagnosis. Results of these and possible other items of importance are
not broken out for the reader to ascertain whether the facility’s program completes
treatment plans on a timely basis or admits a high percentage with an actual substance
abuse clinical diagnosis.
Addictions services does not track the most basic information needed to assess program
effectiveness, such as the percentage of inmates completing the inpatient program.
Department policy requires the Addiction Services Bureau to maintain data, evaluations, and
information regarding measures of treatment outcome success (CD-185200 (Q)). The department
does track some data, such as how many inmates are participating in TC programs each month
and use of bed space. However, the department does not regularly compile outcome information
that shows the program’s effectiveness, including the following.
• Percentage of TC participants testing positive for alcohol/drug use. TC participants are
supposed to abide by a no-drugs policy. Each facility TC program randomly tests TC
participants each month but does not compile or report the aggregate results of these tests
to central office. As a result, the department lacks information needed to assess whether
the overall program is operating relatively drug free. Individuals caught using drugs can
be expelled from the program.
• Percentage of TC participants expelled from the program for non-compliance. Again,
the department tracks the number of individuals expelled, but without additional
information this data is meaningless.
• Percentage of TC participants successfully completing treatment within 12 months. The
department does not track the percentage of inmates that complete TC successfully or in a
useful format to determine completion rates. The TC program is supposed to take about
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•
•

12 months to complete. The department can and does track the raw number of inmates
successfully completing the program, but does not compare this number to the overall
number participating. As a result, the department cannot assess whether the resources
and activity carried out by the program results in high or low percentages of inmates
successfully completing treatment. Lower percentages may indicate a problem with
program operations.
Average cost per TC participant. The department does not routinely examine the average
cost per inmate per day to provide TC services, whether in a public or private facility.
Recidivism rates for all TC participants and for TC graduates. The department has taken
steps to measure these outcomes, but not for graduates. The Addictions Bureau recently
evaluated recidivism rates for TC participants as compared to all inmates released in
2001. The results indicate that 61 percent of all inmates released in 2001 returned to
prison within five years but that a higher percentage, 69 percent, of TC participants
returned. While these are disheartening results, they may not accurately reflect the
effectiveness of the TC program as it operates today or even two years ago. In 2001, the
TC program was still in its infancy according to department staff. A better approach
could be to align TC recidivism data with the department-wide recidivism data efforts
that measure return rates at 12, 24 and 36 months. The department should also separate
TC participant rates from TC graduation rates to fully evaluate whether TC graduates
return to prison at lower rates than TC participants and all other inmates.
Chart 15. N.M. 5-Year Recidivism Rates

Percent Return to Custody

Theraputic Community Participants and
Inmates Released in 2001
75%
70%
65%

69%

60%
55%

61%

50%
45%
40%
No Treatment (n=1,370)

TC Participant (n=565)
Source: NM CD

Recommendations. Work with research experts in the field of correctional substance abuse
treatment to assess the potential impact of program design deficiencies on the overall TC
program’s effectiveness, including mixing of TC inmates with non-TC inmates; mixing of
treatment approaches and not discharging inmates from TC near parole dates.
Complete a plan for including a formal aftercare component to the TC program no later than July
2008. The plan should include how the department will use existing resources as a first option
by coordinating with the NMCD Community Corrections program and the state’s behavioral
health entity, ValueOptions, to provide services to TC graduates. The plan should also include a
method for tracking how many TC graduates end up using community-based substance abuse
services.
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Conduct a CQI study in coordination with the Classification Bureau to identify how often TC
participants are transferred during their treatment. Compare transfer rates of inmates from one
security level to another and transfer of Level II inmates to other Level II facilities during
treatment. Also, identify the number of inmates transferred who do not continue treatment as a
result of the transfer. Report the results to the Cabinet Secretary and Committee staff no later
than November 2007.
Enhance regular CQI audits by including a review of data accuracy as part of the audit and
improving the report format by summarizing audit scores and performance scores at the
beginning of each report.
Begin collecting and reporting TC program performance information including the following:
percent of TC participants testing positive for substance use (monthly); percent of TC
participants expelled for non-compliance (quarterly); percent of TC participants completing
treatment within 12 months (quarterly); average cost per TC participant (quarterly); recidivism
rates for TC participants at 12, 24, and 36 months (quarterly); recidivism rates for TC graduates
at 12, 24, and 36 months (quarterly). Include the data above in an annual report to the
Committee and report progress to Committee staff on a quarterly basis during FY08.
The Committee and Legislature should reconsider increased funding for addictions services until
the department completes and implements the recommendations above.
THE DEPARTMENT DOES NOT REGULARLY ASSESS THE IMPACT OF MENTAL
HEALTH SERVICES ON INMATES’ ABILITY TO FUNCTION IN A PRISON
ENVIRONMENT OR SOCIETY UPON RELEASE.
About 20 percent of all department inmates receive some type of mental health service.
Nearly forty percent of female inmates actively receive mental health services. According to the
department, female offenders are more likely to have issues requiring services than males.
National estimates indicate that about 20 percent of offenders in jails and prisons have a serious
mental illness, according to the American Psychiatry Association.
Prison mental health services focus extensively on medication management, crisis intervention
and limited counseling services to address psychosocial and criminal behavior. About 17 percent
of inmates receive psychotropic medications for their mental illness and six percent participate in
therapy.
The department collects quarterly data on the amount and type of mental health services
provided to inmates. The department also requires its facilities to conduct extensive quality
assurance self-audits for all aspects of care on a quarterly basis. The data and quality assurance
audits were implemented as part of the Duran federal consent decree.
The department’s extensive mental health quality assurance activities focus on compliance
with policies and are not used by management to monitor performance. The quality
assurance (QA) program evaluates quality, timeliness and documentation of clinical services.
The QA self-audits cover high risk items and standards required by department policy, ACA or
NCCHC accreditation standards.
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Many facilities routinely report 100 percent compliance for the 96-item self-audits indicating
that either the facilities are operating at high-performing levels or there are problems with data
integrity. The self-audit tool includes 96 questions. If not meaningful or accurate, these items
end up serving as filler questions that raise the overall compliance scores for each facility and the
department. Total compliance on a routine basis may require the department to reassess whether
to continue tracking this information on a quarterly basis and instead review annually. The
department has not implemented on-site annual compliance audits to test data validity. The
department does conduct peer reviews to ensure clinically appropriate care but the results are not
subject to public disclosure.
Data is not summarized in a manner useful to management and does not include some outcome
information needed to assess effectiveness. Some of the QA items are more important than
others, such as timely access to care. However the format of the report obscures these areas in
different rubrics such as “clinical assessments” and “treatment plans.” As such, certain really
key questions such as timely assessments are hidden in the QA report’s summary of results and
appear to distort, or hide, potential problem areas. For example, the FY06 4th quarter report
shows the SNMCF overall score for clinical assessments is 95.6 percent. But SNMCF appears to
have a significant problem conducting assessments on time, scoring only 56.4 percent. The
facility reported 100-percent compliance on the rest of the section’s questions raising the
facilities overall results.
The department does not use the results of self-audits to adjust how it develops training for staff
or focus additional oversight and resources to either problem facilities or poor performing
services. For example, facilities struggling with quarterly self-audits or data problems could
receive additional on-site reviews from central office. This risk-based approach to using central
office resources would allow all facilities to receive an on-site review but target additional
assistance to facilities that are not performing at acceptable levels. The department could
integrate continuous quality improvement (CQI) studies into its central office oversight to
identify process problems or show patient outcomes on hard-to-measure items.
Mental health and psychiatry do not regularly coordinate quality assurance activities to ensure
effective coordination of services. The department’s psychiatrist performs regular quality
assurance audits of the department’s medical contractor, which is responsible for psychiatric
care. The Mental Health Bureau has not been conducting on-site quality assurance audits of
facilities. Effective mental health services require close coordination between psychiatrists and
other mental health providers.
The department lacks meaningful performance and outcome data to ensure mental health
services. The department’s quarterly performance measures for mental health services are
targeted towards the reception and diagnostic central intake, other non-core duties, or do not
demonstrate the results of services provided. Many of the mental health policies and services are
designed to assist inmates, particularly those with severe mental illness, to live safely in a prison
environment. An outcome from these efforts is reduced suicides and suicide attempts, which are
not regularly measured by the department.

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The following are other critical outcome areas for mental health services that lack meaningful
performance information or regular monitoring.
Aftercare. Mental health staff participates in reentry planning for inmates using services
including making referrals to community mental health providers. However, the department
lacks data or other information to assess how often inmates actually connect and use communitybased services upon release from prison. For many former inmates this connection is vital in
order to continue receiving psychotropic drugs that help stabilize mental health conditions. The
Behavioral Health Collaborative’s creation of a single entity to coordinate community mental
health services provides an opportunity for the department to better ensure continuity of care for
former inmates.
Acute and residential care. The department runs a 104-bed mental health treatment center
(MHTC). The center serves as the system’s acute care mental health hospital and, as space
allows, provides long-term intensive services for inmates. Acute care services seek to stabilize
inmates’ conditions to the point they may safely reside in either an alternative placement area or
general population housing units. The department has not historically measured the
effectiveness of this unit, such as how often inmates return to the MHTC. Community mental
health systems measure the effectiveness of acute care hospitals in this way.
Improved inmate functioning. Mental health services seek to not only stabilize mental health
conditions but to help people lead more productive lives. This is also true for prison systems, in
terms of helping inmates reduce periodic acute conditions as well as live safely and productively
in general population. Measuring these effects has proved elusive for community mental health
services as well. The state’s Behavioral Health Collaborative is developing methods to measure
improved consumer outcomes as a result of mental health services. The department’s
participation with the Collaborative should provide an opportunity to expand this type of
measurement to the prison population as well.
The department lacks needed bed space for acute mental health care for female inmates.
Currently the department sets aside minimal bed space for females at MHTC. However, MHTC
is not designed to safely accommodate both male and female inmates since there is not a fully
separate housing unit. The department has attempted to work with NMWCF to create a small
MHTC unit but the department has historically struggled to obtain professional mental health
services in rural areas. The MHTC could be expanded, but this cost does not appear warranted at
this time. Instead, the newly opened Camino Nuevo facility in Albuquerque may provide the
necessary separate bed space and access to a wider pool of professionals to serve female inmates.
State law requires the department to perform diagnostic evaluations of county jail inmates,
taking up valuable bed space for unknown results. New Mexico sentencing laws allow
judges to commit, for not longer than 60-days, a felon to the department for a diagnostic and
evaluation (D&E) to assist in determining the sentence disposition: prison, deferred or suspended
sentence or probation (Section 31-20-3 NMSA 1978). The department must evaluate the
prisoner and make a recommendation to the court. In CY06, the department admitted 302 males
and 94 females for diagnostic evaluations at an estimated cost of $2.1 million.

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The diagnostic evaluation process has required the department to set aside an entire housing
unit at CNMCF that could otherwise be used for needed medium security bed space. The
department cannot allow mixing of D&E inmates with other committed inmates and must
maintain totally separate housing arrangements for the protection of both inmates and staff. As
of FY05, the state incurred an estimated $97 per day per male D&E inmate and in FY06, an
estimated $62.06 for females at NMWCF.
The continuing need for the department to perform diagnostic evaluations, rather than county
jails, is unclear. The department has not studied how often judges use department
recommendations in determining whether or not to commit an inmate to a prison sentence. At
the time of the statute’s creation, county jails may not have had the professional expertise to
perform D&Es. Modern jails now have the same type of mental health staff who can perform
D&Es as the department.
Having the department make recommendations on whether to commit a person to a department
or contracted prison may be a conflict of interest. Staff who performs D&Es at CNMCF and
NMWCF cannot then treat or evaluate the same inmate if they return to the department’s
custody.
Recommendations. Examine whether to modify, including reducing the number of areas or
questions that appear on quarterly QA self-auditing tools. Some of these items may be more
appropriate to track on an annual basis.
Identify key measures out of the total number of QA compliance measures being tracked. These
should be reviewed and discussed with wardens and central office management at internal
performance meetings. For access to care, include measures related to timely assessments and
timely discharge plans. For quality of care, include measures related to clinical appropriateness.
For documentation, include signed consents.
Begin collecting and reporting the following system-wide outcome measures:
• Suicide rate.
• Rate of suicide attempts resulting in serious injuries.
• Percent of inmates discharged from MHTC who do not require crisis intervention
services within six months.
• Percent of inmates discharged from MHTC who return within six months.
Work with the Behavioral Health Collaborative and experts in New Mexico or nationally to
develop a methodology for demonstrating whether inmates receiving mental health services
show improved functioning. At a minimum, the department should consider targeting those
inmates with characteristics needing more intensive services/or potential for causing self-harm or
misconduct within a general population setting (high risk/high need inmates); and determine
whether a DSM-IV GAF score methodology for a prison setting or other assessment could be
used to measure “improved functioning.”
Identify mutual areas of concern for both mental health and psychiatry services, ensure existing
quality assurance audit tools capture information to monitor these areas and consider conducting
joint on-site annual QA visits to facilities.
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Seek outside training to assist the Mental Health Bureau develop continuous quality
improvement studies and quality assurance best practices for a prison setting. The department
continues to rely heavily on Duran consent decree requirements for QA, which may not meet
current best practices.
Explore further whether the department should set aside a housing unit at Camino Nuevo as a
mental health treatment unit for female inmates and report the decision no later than December 1,
2007, to the Legislative Finance Committee.
Study, in coordination with the New Mexico Sentencing Commission (NMSC) the continuing
need for NMCD to perform diagnostic evaluations, including an assessment of the results of
existing evaluations; actual costs incurred by the department; other financing options; and
alternative settings for the evaluation, such as county detention facilities. Report the results of
the study and any recommendations to the appropriate interim legislative committees and the
Legislative Finance Committee no later than December 1, 2007.
THE DEPARTMENT ENSURES BASIC COMPLIANCE WITH POLICIES BUT
COULD IMPROVE PRISON OPERATIONS FURTHER BY INCREASING ITS FOCUS
ON PERFORMANCE.
The department has implemented an extensive quality assurance (QA) process to ensure
basic compliance with policy and the American Correctional Association (ACA)
accrediting standards. This approach grew largely out of years of litigation related to the
federal Duran consent decree. The current administration has focused resources on achieving
ACA accreditation for its entire prison system. In 2007, the department received ACA’s Eagle
Award for having all applicable areas of department operations accredited. Only five other states
have received this award. Accreditation signifies that the department’s policies and compliance
meet national standards. Committee staff commends the department for its efforts.
Central office does not always use QA information to improve compliance or monitor
performance of public and private prisons. For example, each facility conducts regular file
and compliance audits of their classification system. The facility forwards this report to central
office QA Bureau. However, the results of the audits are not shared with the Classification
Bureau which is responsible for overseeing the classification system at the state level, including
providing training to facility staff. Without this information Classification cannot effectively
help address deficiencies before they result in bigger problems or tailor training to areas or
facilities that need it the most.
The department could increase efficiencies by integrating contract monitoring criteria with
key compliance audits of private prisons. Currently, the department duplicate’s private prison
operator efforts to monitor compliance with department policy and ACA standards through
quarterly audits. The department has a state employee on site at each private facility who in
many cases, carries out the same or similar compliance audits as the private prison’s QA
manager. The contract monitor could instead focus time and resources on other activities related
to performance and adherence to key aspects of the contract, such as staffing requirements,
inmate grievances and classification and re-entry process.
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The QA process does not ensure the accuracy of data submitted by facilities. This data for
existing performance measures is supposed to be used to determine the performance of private
prisons per the contract. The data is also used by the Legislature to determine the department’s
performance.
The department does not measure or monitor performance in key aspects of prison
operations. ACA is moving towards performance-based accreditation that will require the
department to demonstrate not only compliance but the performance of its prisons. As other
portions of this report have indicated the department lacks needed performance measures to
assess program effectiveness for medical and behavioral health services. The department does
not regularly measure performance of its classification system to ensure inmates are
appropriately classified and released from prison on-time. The Committee report regarding the
Parole Board indicates serious problems with New Mexico’s re-entry process and the timely
release of inmates.
The department collects extensive data from facilities on other operational issues, such as
grievances, non-serious inmate assaults, staff vacancies and turnover. In fact, the department
compiles an excellent performance scorecard containing numerous performance measures.
However, management does not use this information to assess whether the prison system is
meeting long-term goals, such as a reduction in low-level violence. The performance score-card
also contains numerous outdated performance measures that may not reflect the department’s
current strategic objectives.
Recommendations. Develop procedures to validate information provided by the facilities to
ensure reliability of the information.
Require private facilities’ contractors to conduct ACA compliance audits to ensure that facilities
are ACA accredited and submit a copy of audit to the department.
Require private facilities’ contract monitors to conduct contract compliance audits to ensure that
contracts are in compliance with current contracts and provide services as required by the
contract. Create a deficiency and corrective action plan database to analyze types of deficiencies
reported on a regular basis and impact of corrective action plan on the facilities performance.
Conduct yearly independent quality assurance audits and follow-up audits of all facilities to
ensure that all facilities are in compliance with standards and private facilities maintain contract
compliance at all times.
Provide results of quality assurance audits and ACA compliance audits to other divisions or
bureaus within the department to address training or other needs of the facilities to address
deficiencies at the facilities.

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IMPROVED MONITORING OF FOOD SERVICE CONTRACTS COULD REDUCE
COSTS AND INCREASE DEMONSTRATED QUALITY.
The Aramark contract provisions are generally structured in the best interest of the
department. The contract includes performance measures and sanctions/penalties associated
with each measure. The larger areas of concern for the department are the execution,
monitoring, reporting and enforcement of the food service contract provisions. Site visits and
document review indicated that many of the food service contract terms were not being executed,
properly monitored and reported and subsequently not enforced by the department. These
findings in effect made the structure of the contract and presence of performance measures and
sanctions clauses irrelevant unless proper departmental oversight was in place.
The department meals call for 3,400 calories per day for an inmate, which is more than
comparable entities and results in more expensive meals. Table 12 shows the department
pays more per meal served than private prisons do in New Mexico and requires higher calories
for its inmates. The department’s contract with Aramark was part of the SaveSmart initiative.
Despite paying higher meal costs than comparable entities, the state paid the SaveSmart vendor
about $300 thousand for estimated savings to the food contract.
Table 10. Unit Cost, Daily Calorie Amount and
Number of Meals Served Comparison
Unit cost

Daily Required
Calories

Aramark

$1.51

3,400

NM Private Facility A

$1.10

3,000

NM Private Facility B

$0.94

3,200

NM Private Facility C

$1.05

Public Correctional Facilities

UNK
Source :NMCD and facilities

Lack of consistent food count policies and ineffective monitoring tools may result in
overpayments. A small sample from two facilities revealed possible overpayment of almost
$4,000 for a one month period. A critical factor in determining the cost of the department’s
food service contract is the number of meals the contractor serves. The department and its
facilities lack a documented meal count procedure. A precise meal count system is essential for
the department to ensure accurate invoices from the contractor. Without an accurate meal counts
there is significant potential for inaccurate billing by the food service contractor.
Some facilities do not routinely compare facility maintained meal count numbers with amount of
billed meals by the contractor leading to possible overpayments. An examination of a sample of
the public facilities’ invoices indicated discrepancies in facility maintained meal counts and the
amount of meals billed by the contractor. For example, based on one month at one unit at one
facility we found a possible overpayment of $3,048.
Inaccuracies exist in the training academy (TA) food service invoices as well. Summit provides
food service to the TA. Based on this sample, it appears that the TA business office staff is not
verifying signatures with the number of meals for which Summit invoices that could lead to
significant overpayment over a longer period of time.
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The table below provides a summary of meal-count differences from the samples examined at
PNM and the department’s TA.
Table 11. Contractor and Facility Meal Count Comparison
Facility
PNM
Training Academy

Sample Dates
June 5-June28, 2006
July 1-31, 2005

Contractor
Meal Count
12,459
1,453

Facility
Meal Count
10,395
1,283

Difference
2,064
170

Cost of
Difference
$3,048
$964

Source: Facility maintained meal count numbers and contractor invoices

Facility and Contractor Document Maintenance Is Lacking. The contract requires Aramark to
generate, maintain, and have readily available several documents critical to the food service
preparation, operations and cost. Review team site visits indicated that facility and contractor
document maintenance was deficient.
For example, kitchen inspection records were not consistently kept; food substitution logs were
not routinely present; food quality surveys were frequently not done or present for inspection;
and employee and inmate food service training certifications were either not done or maintained.
Additionally, contractor generated monthly and quarterly reports were not completed. Without
these reports much of the necessary documentation for assessing contractor performance is
lacking as well as the status reports that document ongoing successes and problems. During
interviews with contractor and facility staff, it was apparent that both sides were not adequately
familiar with the terms of the contract. The facilities also did not emphasize contract oversight
based on the contracts terms therefore allowing the contractor to become negligent in the
completion of some duties.
The department does not regularly monitor or evaluate Aramark contract performance or
enforce sanctions. Department management does not use compliance information generated by
each facility regarding food service for decision making. For example, management does not use
quality assurance reports generated by each facility to monitor Aramark’s performance.
Additionally, the quality assurance audit tool does not review items specific to the particular
contract. The only items that are reviewed in contracts are duplicative with ACA standards.
In 2004, the Aramark contract evaluation and monitoring was decentralized. Instead of one
central office staff member monitoring Aramark’s performance through the contract provisions,
the wardens assigned a staff member at each facility to monitor Aramark’s performance,
typically the facility’s quality assurance manager.
The department does not monitor all the performance measures in the Aramark contract.
Contract performance measures provide objective tools to assess contractor performance and
ensure accountability. When performance problems are identified they are not disseminated to
the appropriate levels of management. Compliance with contractual performance measures is
not assessed; hence penalties associated with the sub-par performance are not enforced.
Recommendations. Establish a department-wide meal count procedure for each facility to
follow and review the procedure with both facility staff and the contractor.
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Compare facility-maintained meal counts with contractor billings and reconcile the differences
before payment is made.
Review the contract with facility staff and contractor to ensure all the terms are met and the
required documentation is generated and maintained.
Reassess the reporting requirements of the contract to ensure all reported items are useful to
NMCD management and facility staff. Determine the useful information needed, the reporting
frequency, the reporting format and track contractor’s compliance submitting required reports.
Use contractor reports to gauge performance, identify issues, and track food service delivery
trends.
Compare the Training Academy self-collected numbers (source data) with contractor generated
numbers to ensure accurate bi-weekly billing.
Redevelop the department audit tool to better capture both ACA standards and key contract
provisions and performance standards. If necessary this audit tool can provide adequate evidence
and documentation to make a decision on a contractor sanction based on performance.
Assign one central office staff to coordinate food service compliance and contract monitoring
activities. This staff person should consolidate the information generated and reported at the
facility level into an aggregate report that provides management with a high level summary of
facility collected information and contractor performance.
Develop an internal procedure to disseminate the information collected at the facility level to
management to assist in making management decisions and engaging contractors.

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51

APPENDIX A
Assertions and Formulas Used in Report
Assertions:
Fixed debt service per diem is calculated on $50 million dollars for LCCF and $27 million
dollars for GCCF plus five percent return on investment over twenty years. In 1998, treasury
bonds were selling at five percent interest rate; therefore, five percent return on investment was
added in actual construction cost for GCCF and LCCF.
According to the contracts of LCCF and GCCF, the department agreed to pay at least 90% of the
facilities rated capacity for LCCF and GCCF. Therefore, we made an assertion that contractor
for both facilities covered fixed debt service cost in first 1080 inmates at LCCF and 540 inmates
at GCCF, 90 percent of the 1200 capacity for LCCF and 600 capacity for GCCF.

Formulas:
•

Historical debt service per diem
o Actual construction cost/life of the asset (20 yrs)/90% of the facilities rated capacity

•

Current debt service per diem:
o
Cumulative CPI times historical debt service per diem

•

Savings from not applying CPI to debt service up to FY06
o Historical debt service minus current debt service times 90% of the facilities rated
capacity

•

Savings from not applying CPI to debt service over ten years
o Savings from restructuring in FY06 from LCCF and GCCF times 10 plus
Additional savings from not applying CPI for 10 years

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52

Other State Comparisons
After various interviews with corrections departments’ staff and review of private facilities’
contracts, the facilities with the following characteristics were selected for comparison:
• Constructed after 1996
• Operated by GEO or CCA
• House medium security male inmates
• Provide similar services to inmates as shown in the table below
Services and Programs Provided to Inmates at Private Facilities

1

Food Service
2
Health Care Services
Academic, Vocational Services
Recreation and Hobby
Religious Activities
Inmate Work and Pay
Inmate Commissary/Canteen

LCCF
9
3

9
9
9
9
9

Idaho
9
9
9
9
9
9
9

Oklahoma
9
9
9
9
9
9
9

Texas
9

GCCF
9

4

9
9
na
9
9

3

9
9
9
9
9

Colorado
9
9
9
na
na
9
9

Montana
9
9
9
9
9
9
9

Source : NMCD and other states' corrections departments
na = Not addressed in the contract.
1
= The contractor is required to provide three meals per day. Three meals must provide 2900-3000 calories for each inmate per day.
2
= Health care services include all medical, mental health and dental services.
3
= New Mexico sub-contracted health care services.
4
= Texas corrections department contracts with the Correctional Health Care Committee to provide complete health care services

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APPENDIX B

HEALTH CARE
IN
NEW MEXICO CORRECTIONS DEPARTMENT FACILITIES
A Report to the Legislative Finance Committee
By
Steven S. Spencer, MD, FACP and B. Jaye Anno, PhD, CCHP-A
April 2007

Health Care in New Mexico Corrections Department Facilities
Steven S. Spencer, MD and B. Jaye Anno, PhD
Report to the Legislative Finance Committee

Table of Contents
Executive Summary

i

Introduction

1

NMCD Central Office

1

Lea County Correctional Facility – Dr. Anno’s Report

4

Lea County Correctional Facility – Dr. Spencer’s Report

9

Central New Mexico Correctional Facility, Dr. Anno’s Report

14

Central New Mexico Correctional Facility, Dr. Spencer’s Report

18

Penitentiary of New Mexico, Dr. Spencer’s Report

24

New Mexico Women’s Correctional Facility, Dr. Spencer’s Report

28

Western New Mexico Correctional Facility, Dr. Spencer’s Report

33

Final Conclusions and Recommendations

36

Executive Summary
In compliance with our contract with the Legislative Finance Committee we have evaluated the
health care provided by Wexford Health Sources, assessed the monitoring and oversight function
of the NMCD, and made recommendations for improvement. Our sources of information
included many relevant documents and reports, at the NMCD Central Office and at individual
prison facilities. Site visits were made to Lea County Correctional Facility (LCCF) and Central
New Mexico Correctional Facility (CNMCF) by Drs Spencer and Anno, and to the Penitentiary
of New Mexico (PNM), New Mexico Women’s Correctional Facility (NMWCF), and Western
New Mexico Correctional Facility (WNMCF) by Dr. Spencer. We had excellent cooperation
from all Wexford and NMCD staff, and we encountered some exceptionally capable Wexford
employees who should be retained.
In regard to the contractor’s performance, the major deficiencies include staffing vacancies for
which no financial penalty has been assessed; failed recruitment and retention programs; an
inadequate Continuous Quality Improvement program; inadequate record and reporting systems;
a chronic illness care program that fails to meet national standards, due partly to the NMCD
requirement to use forms that lack adequate reminders; and an inadequate detoxification
protocol. There is a need for logs and spread sheets that document the timeliness and
completeness of important aspects of care; Nursing Treatment Protocols that do not require
physical assessment skills that are inappropriate for an LPN; arrangements with consultants who
are closer to Hobbs than Albuquerque; a system-wide Hepatitis C tracking system modeled after
the one at WNMCF; a grievance process that records the informal as well as the formal
grievances; and better coordination between psychiatry and mental health staff.
In regard to the NMCD role, authorized staffing is inadequate, needing more physician, dentist,
optometrist, clerical and nursing positions. Physical therapy should be universally available.
Dietitian counseling services and appropriate special diets should be available. The vacant
NMCD Medical Director position is a serious deficiency, greatly compromising the oversight
responsibility of the Department. A full time contract monitor is also recommended. The dismal
geriatric housing at CNMCF is counter-therapeutic. Other space needs include more clinic space
at the level II facility at PNM, and more examining rooms at NMWCF. Equipment needs include
more computer terminals, and expansion of the Pyxis pharmacy system. There is a need for an in
depth review of the Hepatitis C policy concerning access to treatment. NMCD should be
represented at Hepatitis C Treatment Review Committee meetings and should have access to the
collegial review meetings or their immediate transcripts. Intake procedures should include MMR
vaccine for eligible women.
Issues pertaining to both Wexford and NMCD concern the need for improved communication
through a computerized information system accessible at all facilities, with standardized
reporting of important aspects of care.

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

i

Introduction
On January 30, 2007 a contract was signed by David Abbey, Director of the Legislative Finance
Committee of the State of New Mexico and Steven S. Spencer, MD and B.Jaye Anno, PhD,
Contractors. This specified that the Contractors “shall provide professional assistance to the
Legislative Finance Committee (LFC) as outlined below:
A.

Evaluate quality of health care provided by Wexford Health Sources in New
Mexico Corrections Department (NMCD) facilities.

B.

Assess monitoring and oversight function of the NMCD.

C.

Recommend improvements to health care operations.”

This report is offered in response to that stated scope of work. Site visits commenced on
February 2, 2007, with a visit to the NMCD central office, interviewing Dr. Devendra Singh,
Acting Health Services Bureau Chief. Dr. Singh was very helpful in providing information
including many documents and reports. He continued to be helpful in the ensuing weeks,
responding to requests for additional information and reports.
Drs. Spencer and Anno then made site visits to Lea County Correctional Facility (LCCF) on
February 5 and 6, and to Central New Mexico Correctional Facility (CNMCF) on March 1 and 2.
Subsequently Dr. Spencer made site visits to the Penitentiary of New Mexico (PNM) on March
14, to the New Mexico Women’s Correctional Facility (NMWCF) on March 20, and to the
Western New Mexico Correctional Facility (WNMCF) on March 21, 2007.
While Dr. Spencer and Dr. Anno wrote independent sections of this report, they consulted with
each other regarding the final conclusions and recommendations.
The report is organized by facility, but its conclusions and recommendations are system-wide,
since the LFC scope of work asks for this approach.
We must acknowledge the assistance and cooperation we received from all staff, Wexford and
NMCD, at each facility we visited. There was never an effort to conceal or obfuscate, and we felt
that in each case we were treated with honesty, sincerity and helpfulness. For that we are indeed
grateful, as it not only facilitated our work, but made it pleasurable.
NMCD Central Office
Dr. Anno and Dr. Spencer met with Dr. Devendra Singh at the NMCD Central Office. Dr.
Singh’s previous position has been Quality Assurance Manager, but he is now acting Health
Services Bureau Chief. Dr. Frank Pullara has not been fully involved in the Medical Director job
since February last year, having taken a great deal of sick leave and then finally retiring on
October 1 of 2006.
The ADP (average daily population) of the NMCD is now approximately 6800.
There is an open position for clinical physician, what used to be called Department Medical
Director. The organizational chart would show the Health Services Bureau Chief reporting to the
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

1

Deputy Secretary (Erma Sedillo), who reports to the Secretary of the New Mexico Corrections
Department. Positions reporting to the Bureau Chief are: the Administrative Assistant (Janelle
Chavez), the Medical Records Manager who is based at Los Lunas (Sandy LeChalk), Yolanda
Herrera RN, who is the Director of Nurses for the Department, based in Albuquerque, the Mental
Health Director Bianca Martinez, PhD (director of mental health for the state facilities and
indirectly for the contract ones), and the Clinical Psychiatrist, Dan Collins MD who is .75 FTE.
Dr. Singh has contracted with John Robertson, MD at .5 FTE to assist in the position of Medical
Director through June 30 of this year.
Dr. Singh provided us with a number of documents for our review.
Nursing Treatment Protocols.
These state that nursing staff may not elect to give medication without a physician’s signature or
verbal order. The individual protocols for each condition are faithful to this direction. They
include points at which referral to a licensed provider is indicated. Most of the protocols are
quite reasonable. However, since most of the nurses carrying these protocols out are LPNs, the
physical examination expertise required by some of the protocols is inappropriate. For example,
the “Chest pain-cardiac origin” protocol requires listening to the lungs and obtaining an EKG.
The ability of an LPN to make the distinction of chest pain of cardiac origin is questionable, and
if it is suspected, the licensed provider should be notified prior to spending time obtaining an
EKG. In addition, the “Vaginal yeast infection” protocol allows the nurse to dispense
Miconazole nitrate vaginal cream after making her own diagnosis, which is probably not
justified. The protocol does not even include any description of the typical vaginal discharge.
This is another instance in which a licensed provider should be involved in the care the patient.
The chronic care tracking system for Hepatitis C consists of many pages of inmate names and
numbers, but the other columns are not completed, such as the date last seen, next appointment,
etc. There is a packet for each facility. In other words, this chronic care tracking system as
presented to the Central Office is not a tracking system at all and consists merely of a list of
those infected with Hepatitis C.
The weekly Hepatitis C TRC (Treatment and Review Committee) patient lists are more
informative. There is a report titled “Inmates Completed Hepatitis C Medication Treatment”, one
titled “Inmates on Hepatitis C Medication Treatment”, one titled “Inmates Stopped Hepatitis C
Medication Treatment”, and another titled “Active Hepatitis C List”. It is not clear how
frequently these lists are updated, and there may be a need for more integrated statewide
reporting system. The ECHO program gave NMCD a grant for Hepatitis C care. This funds one
nurse. Dr. Sanjeev Arora at the University of New Mexico is the Hepatitis C authority to whom
the TRC presents candidates for treatment. This committee is to include members from the
NMCD and Wexford. The Department buys Hepatitis C and HIV medications from the state
Department of Health. Care of HIV patients is overseen by Dr. Steve Jenison of UNM. New
arrivals are screened for Hepatitis C at intake according to risk factors or at their own request.
HIV testing is also offered, but requires a written consent, and Dr. Singh says about 98% request
this.
New arrivals are also supposed to receive Hepatitis B vaccine, DT vaccine and maybe rubella
vaccine, although Dr. Singh is uncertain about this and refers us to the yellow form in the
medical record.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

2

The Wexford collegial review process occurs weekly and results in a printed report regarding
decisions on off-site referrals. If approved, the on-site physician orders the appointment to be
made within the designated time frame.
The audit tools used by NMCD twice a year are also supposed to be used by Wexford on site on
a more frequent basis. They were used by Dr. Pullara as well. The problem with the tools for
auditing chronic illnesses is that they do not have specific clinical criteria, only calling for
adequate or inadequate.
Tele-psychiatry is being used at WNMCF, LCC F, NMWCF and GCCF (Santa Rosa). This is
done with out-of-state psychiatrists, two of them, who are supposed to come on site every six
months. The other facilities use direct psychiatric services on site. The new RFP will require instate tele-psychiatrists.
There is a lack of consistency regarding the reporting of MRSA. Some facilities reported
monthly and some provide a cumulative report for the whole year. Some of the reports do not
even contain the name of the reporting facility. It would be more appropriate for the central
office to track and trend MRSA cases on a monthly basis, with reports covering all facilities.
A review of the health services monthly reports is of interest. However, one must question the
accuracy when Roswell Correctional Center reports 1163 nursing encounters, a disproportionate
number for the facility population. The definition of nursing encounter needs clarification.
Contract Review
The following points are worthy of note on review of the NMCD — Wexford contract:
P. 4 — The arrangement for NMCD filling vacancies is cumbersome.
P. 7 —Physicians must be ACLS certified. Physician peer review is to occur quarterly. The
contract allows five working days for corporate response to off-site requests. The collegial
review meetings occur weekly.
P. 8 — Are there any minutes of the Wexford/NMCD meetings? These are supposed to occur 10
times a year.
P. 8 & 9 — Intake procedures are outlined here. They include an EKG, if over 50 years of age.
Current CDC recommendations regarding immunizations advise MMR vaccine for women of
child-bearing age.
P. 10 — Sick call may be done by RN or mid-level, LPN not mentioned.
P. 16 — HIV and HCV lab and meds not paid by Wexford.
P. 17 — Monthly on-site pharmacist review and quarterly Pharmacy and Therapeutics
Committee meeting.

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P. 23 — Requires EMR (electronic medical record). Also requires a designated infection control
nurse.
P. 25 — Addresses chronic care clinics.
P. 34 --- Penalties for vacancies
P. 75 — Mental health staff are state employees, except for the psychiatrist.
P. 87 — HIV exclusions and Department of Health arrangements.
Lea County Correctional Facility – Dr. Anno’s Report
Health services at the Lea County Correctional Facility (LCCF) in Hobbs, New Mexico were
audited on February 5th and 6th by B. Jaye Anno, PhD, CCHP-A and Steven S. Spencer, MD,
CCHP-A. Dr. Anno reviewed the health care staffing and their credentials; meeting minutes,
statistics, and policies and procedures; the continuous quality improvement program, timeliness
of sick call, off-site referrals for both medical and psychiatric consults, health care grievances,
and the adequacy of New Mexico Corrections Department’s (NMCD) monitoring of its contract
with Wexford. In doing so, she reviewed a number of documents and interviewed staff.
Introduction
The Lea County Correctional Facility is owned by The GEO Group, Inc. GEO has a contract
with the NMCD to provide housing and other correctional services to approximately 1200 male
inmates. GEO employees also provide mental health services. There is a mental health director,
a clinical supervisor, and six counselors. Medical and dental services, however, are provided
through a separate contract that NMCD has with Wexford. Psychiatric care is also provided by
Wexford via telemedicine.
Staffing and Credentials
Wexford has 19.2 medical and dental positions at LCCF. At the time of our audit, 17.2 positions
were filled. The facility’s medical director position has been vacant for at least two months. Dr
Velasquez from Roswell comes in on week-ends to help out. Dr. Anno was told that a physician
has been hired to fill the slot, but he cannot work until he receives his New Mexico license.
LCCF also has a vacant night RN position. Coverage for this position is provided by a PRN
(“as needed”) LPN or other nursing staff working overtime.
All qualified health professionals had proof of licensure on file at the facility. The dentist and
the physician’s assistant (PA) also had current DEA licenses. All professional staff were current
in CPR certification except the part-time dentist and one LPN.
While the number of positions Wexford has is consistent with the 19 positions suggested by
NMCD in Appendix D of their contract, we question whether this staffing is sufficient to
accomplish the scope of work in the body of the contract. For instance, in Section II.J.3., the
contract states that the oral health program “shall provide for the basic oral health needs of the
inmate population …to maintain optimal (emphasis added) oral health and to restore adequate
function and mastication,” yet the suggested minimal staffing for dental services is only a 0.4
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

4

dentist, a 0.6 dental assistant, and no hygienist, which is what Wexford has. Historically,
inmates have extensive dental needs, and a 0.4 dentist would barely have time to address urgent
conditions for 1200 inmates let alone provide “optimal” care. The wait time for routine dental
care now is about two months. Also, there is only one clerical position and nursing time needs
to be increased.
Meeting Minutes, Statistical Reports, and Policies and Procedures
Dr. Anno reviewed the meeting minutes and statistical reports for 2006. Meetings with the
warden, mental health staff, and relevant health services staff (“MAC” meetings) were held
monthly. Wexford staff meetings were also held monthly. Health services statistical reports
were compiled monthly. LCCF does have a site-specific policy and procedure manual.
Continuous Quality Improvement (CQI) Program
Wexford refers to its internal CQI efforts as “Quality Management.” There is a Quality
Management Program manual for 2006 developed by corporate office. On page 5, it lists 23
items to be reviewed annually at each site. Audit tools are included. The items to be reviewed
are consistent with the requirements of the National Commission on Correctional Health Care’s
guidelines on CQI. Wexford’s manual also requires quarterly audits of chronic care clinics and a
reporting calendar. At the front of this manual, LCCF staff signed that they had reviewed it.
From the list of the required 23 items to be audited, the LCCF health services administrator
developed a schedule of which audits were to be done each month. Dr. Anno reviewed these
audits and found them to be consistent with corporate requirements. There were also two yearlong studies to be conducted: a process study on sick call and an outcome study on diabetes.
However, in the material Dr. Anno was given to review, data collection did not occur quarterly.
Data were gathered for the process study in August and October, and for the outcome study in
June, August, and October. It was not possible to determine how well LCCF staff were doing in
either of these areas, because the summaries have not yet been completed in either study.
While for the most part, Wexford staff at LCCF are following corporate requirements for
conducting CQI studies, a question remains as to the effectiveness of this approach. To be useful
for the staff at a specific site, CQI studies should be problem solving, not paper pushing. In
other words, staff at a given site should review aspects of care that are not operating as
efficiently or effectively as they would like at their particular facility. Simply completing the
studies designed by corporate office is not going to solve problems at the local level.
Sick Call
Wexford uses a written sick call request system for routine care. Inmates obtain the slips from
correctional officers in their housing units. They fill them out and put them in a medical box.
Nursing staff collect the slips Sunday through Thursday. Nurse sick call is held Monday through
Friday. If inmates put their slips in by noon, they are seen the next day (except on the weekend).
Nurse sick call is held in the exam rooms in the housing units. If the inmate’s complaint can be
handled with over-the-counter medication pursuant to nursing protocols, that is accomplished. If
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

5

something more is required, the inmate is put on the list to see a provider, which can take up to
two weeks after the referral.
Dr. Anno requested ten charts from the sick call list of 12/29/06: five from segregation and five
from housing units 2 and 3. Two individuals had left the facility, so she reviewed eight charts as
noted below. Personal information of inmates and Wexford staff has been removed from
Appendix B.

ID#
54245
56486
59145
63900
59873
41517
61945
49202

Housing
Unit
Seg
Seg
Seg
H 2 &3
H 2 &3
H 2 &3
H 2 &3
H 2 &3

Date of
Request

Date
Rcvd

12/25
12/27
12/27
12/27
12/12
12/27
12/26
12/22

12/28
12/28
12/28
12/28
12/28
12/28
12/28
12/28

Date seen
by nursing
12/29
12/29
12/29
12/29
12/29
12/29
12/29
12/29

Date seen
by provider Complaint
1/8
1/3
NA
2/14 sched.
NA
1/3
1/5
1/3

blood in stool
pain
cough
Pain
paper signed
back pain
ear flush
collarbone

There are a few problems with the current sick call system. First, NCCHC standards as well as
Wexford’s contract with NMCD (Section II.F.2.a.) require nursing staff to pick up sick call
requests and review them seven days per week, not five. Second, Dr. Anno was told that inmates
who do not show for sick call for any reason (including lockdowns) must submit a new sick call
request. This is inappropriate. Any individual not seen for any reason other than a refusal of
care should be scheduled automatically for the next sick call. Finally, two weeks is too long of a
delay to see a provider.
More puzzling is the requirement (II.F.2.a.) in NMCD’s contract with Wexford stating that triage
and screening “…shall take place through direct contact with the inmate by a registered nurse
(RN) or mid-level provider (NP or PA).” NMCD’s suggested minimum staffing for LCCF in
Appendix D of the contract calls for 8.4 LPNs and only two RNs, one of which is not currently
filled. With this staffing pattern, it should not be surprising that LPNs do the triage and
screening for sick call.
Off-site Specialty Referrals—Medical
When a provider at LCCF makes a referral for off-site specialty care for a medical condition, the
referral goes to the administrative assistant. She faxes the referrals to Wexford’s corporate
office, and each Wednesday, a conference call is held with Wexford’s regional physician and the
LCCF provider to discuss the case. The regional physician decides whether to approve the
referral or to defer a decision pending alternative treatment or gathering additional information.
This process is referred to as “collegial review.” Under the terms of its contract with NMCD
(Section II.D.2.), Wexford has five working days to respond to non-urgent consultation requests,
which they are meeting.
The contract also specifies the time frames for completing the appointment to a specialist by
discipline (Section II.G.3.). For example, a routine referral for urology must be completed
within 60 days whereas one for oncology must be completed within 30 days. Approved specialty
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

6

referrals are sent to NMCD’s Bureau of Health Services. Staff there track the timeliness of
outside specialty referrals.
One problem identified is that the administrative assistant at LCCF only tracks the referrals that
are approved. It does not appear that anyone at NMCD’s Bureau of Health Services reviews the
cases that are deferred to determine whether the deferral was medically appropriate. This is an
important oversight function and should be a part of the next vendor’s contract.
Dr. Anno tried to determine the number of referrals that had been deferred by comparing the list
of names presented by the LCCF provider with the list of approved referrals from corporate
office. She asked for copies of both lists for December 2006 and January 2007. Unfortunately,
the administrative assistant only had copies of both lists for four weeks as noted below.
Date of Collegial
Review
11/30/06
12/21/06
1/18/07
1/25/07

# of Referrals
by LCCF
8
6
15
11

# Approved by
Wexford
1
2
8
4

Of the 40 cases presented those four weeks, only 15 (37%) were approved by Wexford.
However, without an NMCD physician reviewing the cases that were deferred, it is impossible
for NMCD to know whether those decisions were medically appropriate.
Dr. Anno looked at the charts of the inmates who were deferred on 1/25/07. Inmate #54078 was
referred for an MRI of his knee and Wexford’s regional physician wanted more information.
Inmate #56473 was referred for an optical evaluation and Wexford’s physician wanted him
reevaluated by the optometrist. Inmate # 59153 was referred for an ophthalmology consult, and
Wexford’s physician wanted him to be seen by the optometrist first. In the remaining four cases
(# 22343, 41078, 32901, and 64650), paper work in their charts indicated that their referrals had
been approved, but for some reason, they were not on the corporate approval list. At a
minimum, the LCCF administrative assistant needs to check her list against the corporate list to
ensure that all of the inmates who are approved for outside consults get scheduled.
Finally, Wexford’s contract with NMCD (Section II.G.1.) states that the “CONTRACTOR shall
endeavor to consolidate the scheduling of appointments and services for inmates with
community physicians, hospitals and other providers and services to minimize the impact upon
security staff, and available vehicles.” However, Wexford uses a provider in Albuquerque for
its off-site consultations, which is about a six-hour drive from Hobbs. This not only places a
burden on security staff and vehicles, but it serves as a disincentive for inmates to complete their
appointments, because they have to go to Albuquerque and back the same day.
Psychiatric Consultations
Wexford is also responsible for psychiatric consultations. GEO mental health staff make the
referrals and give them to Wexford’s clinic coordinator. She, in turn, sets up the appointments
with one of two psychiatrists who see patients via telemedicine. Unfortunately, Dr. Anno was
told that the equipment does not always work and that the audio is choppy. In fact, both the
Monday and Tuesday psychiatric clinics were cancelled when we were on-site. The GEO mental
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Steven S. Spencer, MD and B. Jaye Anno, PhD

7

health director has only recently begun to track the frequency of cancellations of the psychiatric
clinics. This should be tracked regularly so the problem can be addressed by Wexford.
Dr. Anno also reviewed the log that GEO staff keep of their mental health caseload. She
identified eight individuals who were not followed up appropriately as follows:
Inmate # 64765: He should have been scheduled to return to the psychiatric clinic on
9/13/06. He had not been scheduled yet.
Inmate #60302: He was scheduled to return to clinic on 12/6/06. He has not been seen,
but was rescheduled for 2/13/07.
Inmate # 64955: He was supposed to be seen on 12/14/06. He was not and has not been
rescheduled.
Inmate #55600: He was scheduled to be seen on 12/12/05. He was not and was never
rescheduled.
Inmate # 65285: He was scheduled to be seen on 1/10/06. He was not and has not been
rescheduled.
Inmate #63939: He was scheduled to be seen on 11/13/06. He was not and has not been
rescheduled.
Inmate #59904: He was scheduled to be seen on 12/15/06. He was not and he has not
been rescheduled.
Inmate # 59145: He was scheduled to be seen on 9/01/06. He was seen on that day and
scheduled to return to clinic on 10/3/06. He was not seen on 10/03 and has not been
rescheduled.
Obviously, a better system needs to be put in place to ensure that psychiatric patients are
followed on a timely basis.
Grievances
Dr. Anno reviewed all of the health care grievances for 2006. Surprisingly, there were only 148
health care grievances for the entire year. This is an average of only 12 per month, which
represents only one percent of the population. We recommend that NMCD health staff interview
a sample of inmates to determine whether the present grievance system is effective.
Contract Monitoring
LCCF has a full-time contract monitor. However, he is only responsible for monitoring
NMCD’s contract with The GEO Group. NMCD’s Bureau of Health Services is responsible for
monitoring the Wexford contract, but there is no designated contract monitor position. The
position of Bureau Chief was held by a physician until a year ago when he went on extended
medical leave. Currently, there is an acting Bureau Chief, a vacant quality management position,
a 30 hour per week clinical psychiatrist, a state-wide director of nursing, a state medical records
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

8

manager, and an administrative assistant. The acting Bureau Chief held the quality management
position until recently. He indicated that NMCD plans to hire a clinical physician sometime
soon.
Bureau of Health Services staff do audit the Wexford facilities at least annually. However, their
auditing tools are designed more to determine the extent of the facilities’ compliance with
national standards rather than compliance with specific terms of Wexford’s contract. The current
contract provides for numerous financial penalties to be assessed if Wexford violates specific
terms (see Sections IX.2.1-21 and IX.3). However, these areas are not all regularly monitored by
the Bureau of Health Services. The only financial penalty ever assessed against Wexford was in
2002 for $35,000 owing to insufficient psychiatric coverage. On the medical side, Wexford has
refused to provide staffing vacancies until recently, according to the acting Bureau Chief. The
last two quarters, Wexford has reported aggregate staffing levels, but not site-specific
information. This should be a requirement of the new contract.
We recommend that a health care contract monitoring position be approved by the legislature in
time for the contract with the new vendor. The almost $34 million spent on this contract
annually as well as the potential liability to the state if adequate care is not provided justify
adding this position. This individual should be a state employee and should NOT be paid by the
vendor as provided for in Wexford’s contract (Section IX.1.4). The position may well pay for
itself if the financial penalties for staffing vacancies and other areas of non-compliance are
actually tracked and assessed.

Lea County Correctional Facility – Dr. Spencer’s Report
Plant and equipment:
My inspection of the facility showed the place to be spacious and clean.
deficiencies were noted, however:

The following

There were no paper towels in the inmate bathroom.
There was no peak flow meter in the Cabinet, where it was supposed be located. The PA
said that he left it at home in the pocket of another jacket.
The radiation certificates posted in the x-ray rooms were out of date. The last one from
the state radiation control Bureau was dated January 25, 2005. The certification of
registration to operate in New Mexico had expired on September 30, 2006. However the
“Intellamed” inspection stickers on the equipment itself were current.
Programs and Staffing
An x-ray tech comes in for one day every other week, to take plain films. These are developed
on site and taken back to Lubbock, Texas. Urgent cases go to Lea Regional Medical Center
(LRMC).
All laboratory specimens are sent to SED Labs. Dipstick urinalyses are done in the exam rooms.
Accucheck blood sugars are done in the clinic. A courier comes in the early afternoon daily
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Steven S. Spencer, MD and B. Jaye Anno, PhD

9

from SED Labs, Monday through Friday.
The pharmacy has ample space and stock medications. A standard k.o.p (keep on person) policy
excludes psychotropic medications. There is a Medline at the clinic for all inmates except those
in unit one, which is a P.C. (protective custody) unit. The Medline is held b.i.d. (twice a day) at
7 a.m. and 7 p.m. A medication cart is taken to unit one, and a separate Medline is held there.
All psych meds are crushed or floated. A consulting pharmacist makes an inspection monthly,
and I reviewed the last report, of January 9, 2007.
Optometry services are provided by a father and two sons, who come in on Saturdays. The
optometry equipment appears to be first-rate.
The dental assistant has been in her job since August of 2006. She was very frank and helpful
about the problems with dental services. The dentist, Dr. Puckett, was supposed to be on site
every Friday and Saturday. However he is now going to school for further training. So was on
site only twice in January and 1 1/2 days in February. He sees 15 to 16 patients per day. There
is a wait time of about two months for non-emergency cases. The dental assistant says that she
was caught up last fall, but fell behind when Dr. Puckett started school, even though another
dentist came in to help out in September and October, Dr. Vincent Straley. Dental sick call
requests are triaged by a nurse who actually sees the patient and then refers to the dental assistant
for scheduling.
Health maintenance and periodic health assessment are done in accordance with a birthday list.
Inmates are given annual PPD test and a DT vaccine if needed, as well as a physical exam
yearly, if over 50, otherwise biennially. I reviewed the PPD testing logs and find that the results
of the tests are not recorded on the logs, though there is a column to do this. The number of
positive tests, however is reported on the monthly HSR report. There are currently three inmates
receiving INH.
[According to Wexford staff] there was an increased prevalence of MRSA infection in housing
unit one last summer. A thorough inspection was therefore carried out, all skin lesions were
cultured and treated, the unit was cleaned thoroughly, tattoo guns were confiscated, and the
number of cases has decreased since. I reviewed the infection control manual and find no
problems with it. There is no designated infection control nurse.
I also reviewed the Wexford, Policies and Procedures Manual. In my judgment the one on
detoxification, intoxication and withdrawal is inadequate. It mentions a few symptoms that
indicate progression of the condition and says that these inmates should be kept under constant
observation by qualified healthcare staff, or sent to CNMCF-LTCU or to the nearest hospital if
severe. However, there is no scoring system, no guidelines for monitoring severity. I strongly
recommend that the CIWA (Clinical Institute Withdrawal Assessment) protocol and scoring
system be adopted. It is readily available on line.
There is no physical therapy service available here, and there has been none for the last four
years, according to [Wexford staff].
A treatment review committee meeting is held every Monday, but no Hepatitis C patients are on
treatment here due to the absence of a Medical Director. All such patients are sent to CNMCF.
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Steven S. Spencer, MD and B. Jaye Anno, PhD

10

There are currently six HIV patients on treatment, and Dr. Steve Jenison comes on site to see
them approximately once a month. His last visit was in December.
Peer review reportedly is done by the regional medical director.
“Staffcare” is a temp agency, which is providing the PA. The PA has been here over a year, but
prefers not to work for Wexford.
Sick call is done by LPN and RNs, rotating this responsibility. A physician or the PA signs off
on their work.
There are no electronic medical records as required by contract.
There are no pharmacy and therapeutics committee meetings, only monthly staff meetings.
Infection control meetings are also held as a part of the regular staff meetings. I did not review
the minutes of these meetings.
Telemedicine is used only for psychiatry, three times a week. Dr. Kalwaski and Dr. Nielsen each
have their own caseload. They came on site once last year, not twice as required by contract.
[Some Wexford staff are] very unhappy with the Wexford operation citing a number of cases
that “fell down a crack,” the collegial review process and cited for example, a patient with a
colostomy that should be re-anastomosed, but was denied. [Staff] cited another case of a cataract
that should be operated but was denied; another one who was denied referral to an allergist, and
cases of chronic illness that had gone months without their being seen. One such was a diabetic
who went from February 2006 to January 2007, without being seen by a provider although he
continued to receive his daily insulin. [Staff] said that diabetic diets are not correct, that they
have no calorie restriction and pointed out that since Dr. Pullara left the job year ago there has
been no NMCD participant in the collegial review meetings.
Dr. Velasquez has been working for Wexford only since last October. He has been regularly
providing services at RCC two days a week for four hours each. He also covers some of the
juvenile facilities. He does not attend collegial review meetings. He has no complaints about
Wexford. He has been coming to this facility since December, mostly on weekends, but did
provide two whole weeks of coverage, this being the second of those weeks. The first was
January 15-21, and also one weekend in December.
The nurses on duty asked if they could meet with me collectively, and this was done. They were
all unhappy, and attributed the problems to insufficient numbers of nursing staff, and also to the
administrative style of the HSA, who they said was unreasonable in her demands and interferes
with their ability to do their job, and that she requires them to continue medications beyond the
expiration date of the order. The new Director of Nursing has been in place only for 2 1/2
months and is already interviewing for another job. [Some] of the LPNs have been here [for a
long time], but the others a much shorter time. They also feel that having only one nurse on duty
at night is not safe, nor is it adequate for patient needs.
Physician and Dentist Staffing
A review of the physician staffing for the past five months shows that a physician was on site 21
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

11

days in September, 22 days in October, and 20 days in November, all of these being Dr.
Apodaca. He then left, and December shows 16 days of on-site physician and January only seven
days.
A dentist was on site 5 days in September, 9 in October, 6 in November, 8 in December, and
only 3 in January.
Chronic Illness Care
I made an effort to select charts to review from the Chronic Care Tracking System. However,
this log is very far out of date and incomplete. When I inquired about this I was told that it was
because the nurses had failed to make an appropriate date entry in the log after a patient was
seen. However, the problem seems to be greater than that. There are erroneous diagnoses,
notably the eight cases of diabetes insipidus. On further investigation, I found that there are no
cases of diabetes insipidus, and that these are all diabetes mellitus. There are also many cases
listed with no diagnosis, and some with other erroneous diagnoses. In other words, the log is
inaccurate and not very useful, and my attempt to make a random selection of charts became a
hit or miss exercise.
I was told that all the clinical forms used by Wexford are actually NMCD forms. In the case of
the chronic care forms, this is unfortunate, because the Wexford forms are preferable. Wexford’s
chronic care guidelines are reasonable and comply with national guidelines. They refer to their
appended chronic illness clinic form, which is one form to be used for all clinics, and they refer
to their disease specific flow sheets. These flow sheets include brief reminders of the parameters
to be followed. Regrettably, this is not the system followed by Wexford, under direction from
the NMCD. The NMCD chronic care clinic form is a hybrid of encounter form and flow sheet,
not specific to any individual condition and not useful as a flow sheet. As an expected result, my
review of the medical records showed a number of instances of failure to comply with standard
chronic care guidelines.
Records of two patients with HIV infection were selected for review.
appropriate. Dr. Jenison had seen them both on December 13, 2006.

Their care seemed

The records of five patients with diabetes were selected for review. Only one of these patients
had documentation of a careful foot examination on his last visit. This is required by the
guidelines, but there is no reminder on the encounter form. Blood sugar control was poor in
three of these five patients, one of whom had not been followed closely enough, having gone six
months between visits. Of the three patients receiving insulin, only one was reliably getting
twice daily glucometer tests. Of the five patients, only one had the desired blood pressure of less
than 130/80. All five had had the required annual blood chemistry and lipid profile. However,
only two had received an annual electrocardiogram. Only three had annual microalbuminuria
tests. Four of the five had had annual urinalysis and fundoscopic examination. Four of the five
were appropriately receiving an ACE inhibitor and four were receiving aspirin. Only three of the
five had received Pneumovax and annual influenza vaccination. There was no evidence of diet
counseling in any of these patients.
The medical records of five patients listed as having asthma were selected for review. However,
one of them did not have any evidence of asthma at all and one had asthma so mild that I
excluded him from review. Of the remaining three, a peak expiratory flow rate was tested on
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

12

each visit only in two of the three, a baseline chest x-ray had been done in only two, and none of
the three had received Pneumovax or annual influenza vaccine. It is of interest that the Wexford
chronic care guidelines do not require either of these vaccinations for patients with chronic
respiratory conditions, although they should.
The records of four patients with epilepsy were chosen for review. All four of these patients
received appropriate laboratory tests every six months including drug levels. Drug side effects
were addressed at each visit in only one of these patients. (The chronic clinic form does not
include a reminder for this.) Only two of these patients had not had a seizure since the previous
visit, but the other two patients’ lack of satisfactory control was being appropriately addressed.
All four had been restricted to lower bunks.
The medical records of three patients with hypertension were selected for review. None of these
had adequate control of their blood pressure.
In summary, the chronic care program at LFCC is far from satisfactory.
Conclusion
The health care program at LCCF suffers from the following problems or deficiencies:
•

The x-ray equipment inspection and certification is in need of updating.

•

Staffing is inadequate, especially nurse staffing, and the turnover rate is unacceptably
high.

•

Physician staffing has been irregular and insufficient for the past two months.

•

Dentist staffing has also been insufficient for the past two months.

•

Record-keeping and tracking has been inadequate.

•

The detoxification protocol is inadequate, and I recommend adopting the CIWA one.

•

There is no physical therapy service available as required by contract.

•

There has been no NMCD participation in the off-site collegial review meetings.

•

There have been no pharmacy and therapeutics committee meetings.

•

There are no electronic medical records as required by contract.

•

The chronic illness clinic program is unsatisfactory. The logs are grossly inaccurate and
incomplete. There are many examples of failure to follow guidelines. The forms that are
in use should be replaced using Wexford’s or ones similar to those. One staff person
should be assigned the responsibility for the organization and tracking of chronic illness
clinic patients. The CQI program should monitor the chronic illness program using tools
that reflect compliance with specific guidelines.

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

13

•

Last but far from least, there is a dysfunctional working relationship between
management and staff. This is probably responsible for the difficulties in recruitment and
retention.
Central New Mexico Correctional Facility – Dr. Anno’s Report

Health services at the Central New Mexico Correctional Facility (CNMCF) in Las Lunas, New
Mexico were audited on March 1st and 2nd by B. Jaye Anno, PhD, CCHP-A and Steve Spencer,
MD, CCHP-A. Dr. Anno reviewed the health care staffing and their credentials; meeting
minutes, statistics, and policies and procedures; the continuous quality improvement program,
timeliness of sick call, off-site referrals for both medical and psychiatric consults, health care
grievances, and the adequacy of New Mexico Corrections Department’s (NMCD) monitoring of
its contract with Wexford. In doing so, she reviewed a number of documents and interviewed
the following people on-site.
Introduction
The Central New Mexico Correctional Facility houses approximately 1400 male inmates. There
are 330 Level I beds, 330 Level II beds, and 720 general population beds (including 300 in the
Reception and Diagnostic Center [RDC]). There is also a 35 bed long-term care unit (LTCU)
and a 104 bed mental health treatment center (MHTC) that includes 20 acute care beds. Medical
and dental services are provided through a separate contract that NMCD has with Wexford.
Psychiatric care is also provided by Wexford via telemedicine. Mental health services are
provided by NMCD employees.
Staffing and Credentials
Wexford has 80.325 medical and dental positions at CNMCF. At the time of our audit, there
were two RN vacancies, a PA Vacancy, and one MD vacancy. The latter two positions were
expected to be filled on March 5th. Coverage for the vacant nursing positions is provided by
agency nurses or other nursing staff working overtime.
All but four qualified health professionals had proof of current licensure on file at the facility,
and these had just expired the previous day. The administrative assistant was working to get
them updated. All but three providers had proof of current licensure and DEA registration on
file. Again, for these three, they had just expired and the administrative assistant was following
up. Five of the 14 providers were not current in CPR certification.
Meeting Minutes, Statistical Reports, and Policies and Procedures
Dr. Anno reviewed the meeting minutes and statistical reports for 2006. Meetings with the
warden, mental health staff, and relevant health services staff (“MAC” meetings) were held only
three times during 2006 and not at all during the first two months of 2007. The health services
administrator (HSA) stated he had only been there a few months and was still learning his job.
There was no evidence that Wexford staff met monthly. According to the HSA, they just started
tracking attendance and developing minutes in January of this year. Health services statistical
reports were compiled monthly. CNMCF does have a site-specific policy and procedure manual.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

14

Continuous Quality Improvement (CQI) Program
Wexford refers to its internal CQI efforts as “Quality Management.” There is a Quality
Management Program manual for 2006 developed by corporate office. On page 5, it lists 23
items to be reviewed annually at each site. Audit tools are included. The items to be reviewed
are consistent with the requirements of the National Commission on Correctional Health Care’s
guidelines on CQI. Wexford’s manual also requires quarterly audits of chronic care clinics and a
reporting calendar
From the list of the required 23 items to be audited, the CNMCF health services administrator
developed a schedule of which audits were to be done each month. Dr. Anno reviewed these
audits and found them to be consistent with corporate requirements. There were also two yearlong studies to be conducted: a process study and an outcome study. However, these studies
have not been started.
While for the most part, Wexford staff at CNMCF are following corporate requirements for
conducting CQI studies, a question remains as to the effectiveness of this approach. To be useful
for the staff at a specific site, CQI studies should be problem solving, not paper pushing. In
other words, staff at a given site should review aspects of care that are not operating as
efficiently or effectively as they would like at their particular facility. Simply completing the
studies designed by corporate office is not going to solve problems at the local level.
Intake Process
CNMCF serves as the reception center for male inmates for the state. New admissions are
screened by nurses the day they arrive. A physical exam is provided within 7 days. Inmates also
receive a mental health evaluation and a dental examination.
Dr. Anno requested 12 charts from the new admissions list to determine the timeliness of
CNMCF’s intake process. One individual had transferred out and one chart could not be located.
Of the 10 charts reviewed, the results were as follows:
Inmate#
65006
64900
66015
65259
66152
66181
62870
66210
66222
66247
63320

Date of RS
6/7/06
11/3/06
1/10/07
2/7/07
2/8/07
2/13/07
2/15/07
2/16/07
2/21/07
2/22/07
2/21/07

Date of PE
6/20/06
11/29/06
1/15/07
2/16/07
2/16/07
2/19/07
2/20/07
2/20/07
2/26/07
3/1/07
2/27/07

Date of MHE
6/7/06
11/9/06
1/10/07
2/7/07
2/8/07
2/13/07
2/15/07
2/22/07
2/26/07
2/22/07
2/22/07

Date of Dental Exam
6/19/06
5/24/06?
1/31/07
2/26/07
2/22/07
None
2/20/07
None
None
None
None

Key: RS=receiving screening, PE=physical exam, MHE=mental health evaluation

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

15

From the chart reviews listed above, physical exams are not always completed within 7 days as
required by NMCD policy and the standards of the National Commission on Correctional Health
Care (NCCHC). Initial mental health evaluations appear to be completed on the day of arrival,
which is excellent. According to NCCHC standards, dental exams should be completed within
30 days of an inmate’s arrival. In five instances, the 30 days had not lapsed. In the other five
cases, dental exams were completed within 30 days.
Sick Call
Wexford uses a written sick call request system for routine care. Inmates obtain the slips from
correctional officers in their housing units. General population inmates fill them out and put
them in a medical box located at the dining hall. Nursing staff collect the slips for segregated
inmates during med pass. Nurse sick call is held Monday through Friday. If inmates put their
slips in by noon, they are seen the next day (except on the week-end).
Nurse sick call is held in the clinic or in an exam room in the segregated housing units. If the
inmate’s complaint can be handled with over-the-counter medication pursuant to nursing
protocols, that is accomplished. If something more is required, the inmate is put on the list to see
a provider.
Dr. Anno requested ten charts from the sick call lists of 2/19/07 and 2/21/07: three RDC, three
from segregation, and four from general population. Two individuals had left the facility, so she
reviewed eight charts as noted below.

ID#
46002
66164
65794
63001
55361
64366
46481
33021

Housing
Unit

Date of
Request

Date
Rcvd

Date seen
by nursing

RDC
2/19/07 2/20/07
NA
RDC
Health service request not in chart
Seg
Health service request not in chart
Seg
2/18/07
Seg
2/18/07 2/18/07
2/19/07
GP 2/18/07
GP Health service request not in chart
GP 2/17/07
2/19/07

Date seen
by provider
2/21/07

2/21/07
2/22/07
2/19/07
2/21/07

While sick call does appear to be provided on a timely basis, there were some problems with
recordkeeping.
Off-site Specialty Referrals—Medical
When a provider at CNMCF makes a referral for off-site specialty care for a medical condition,
the referral goes to the off-site specialty coordinator. She faxes the referrals to Wexford’s
corporate office, and each Thursday, a conference call is held with Wexford’s regional physician
and the CNMCF provider to discuss the case. The regional physician decides whether to
approve the referral or to defer a decision pending alternative treatment or gathering additional
information. This process is referred to as “collegial review.” Under the terms of its contract
with NMCD (Section II.D.2.), Wexford has five working days to respond to non-urgent
consultation requests, which they are meeting.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

16

The contract also specifies the time frames for completing the appointment to a specialist by
discipline (Section II.G.3.). For example, a routine referral for urology must be completed
within 60 days whereas one for oncology must be completed within 30 days. Approved specialty
referrals are sent to NMCD’s Bureau of Health Services. Staff there track the timeliness of
outside specialty referrals.
One problem identified is that the off-site coordinator at CNMCF only tracks the referrals that
are approved. It does not appear that anyone at NMCD’s Bureau of Health Services reviews the
cases that are deferred to determine whether the deferral was medically appropriate. This is an
important oversight function and should be a part of the next vendor’s contract.
Also, the off-site coordinator does not track the timeliness of the outside specialty referrals.
There is no way to tell when or whether an appointment has occurred except to pull each
individual’s chart. “Date of appointment” and Date seen” should be added to the Collegial
Review Log. Finally, appointment cancellations owing to lack of transportation are not currently
tracked. This is important to monitor regularly.
Psychiatric Consultations
Wexford is also responsible for psychiatric consultations. Mental health staff make the referrals
and give them to Wexford’s psychiatric staff. According to the mental health staff Dr. Anno
spoke with, inmates are usually seen the next session after the referral.
Grievances
Dr. Anno reviewed all of the health care grievances for 2006. Surprisingly, there were only 50
informal and 21 formal health care grievances for the entire year. This is an average of only 4
per month, which represents significantly less than one percent of the population. We
recommend that NMCD health staff interview a sample of inmates to determine whether the
present grievance system is effective.
Other Issues
There is a small geriatric population at CNMCF. The conditions under which they live are
disgraceful. They are housed in three dilapidated trailers. The quarters are cramped and there is
barely enough room for wheelchairs to pass down the aisle. The floors are rotting and some of
the plumbing does not work. This situation needs to be remedied as soon as possible.
Contract Monitoring
NMCD’s Bureau of Health Services is responsible for monitoring the Wexford contract, but
there is no designated contract monitor position. The position of Bureau Chief was held by a
physician until a year ago when he went on extended medical leave. Currently, there is an acting
Bureau Chief, a vacant quality management position, a 30 hour per week clinical psychiatrist, a
state-wide director of nursing, a state medical records manager, and an administrative assistant.
The acting Bureau Chief held the quality management position until recently. He indicated that
NMCD plans to hire a clinical physician sometime soon.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

17

Bureau of Health Services staff do audit the Wexford facilities at least annually. However, their
auditing tools are designed more to determine the extent of the facilities’ compliance with
national standards rather than compliance with specific terms of Wexford’s contract. The current
contract provides for numerous financial penalties to be assessed if Wexford violates specific
terms (see Sections IX.2.1-21 and IX.3). However, these areas are not all regularly monitored by
the Bureau of Health Services. The only financial penalty ever assessed against Wexford was in
2002 for $35,000 owing to insufficient psychiatric coverage. On the medical side, Wexford has
refused to provide staffing vacancies until recently, according to the acting Bureau Chief. The
last two quarters, Wexford has reported aggregate staffing levels, but not site-specific
information. This should be a requirement of the new contract.
We recommend that a health care contract monitoring position be approved by the legislature in
time for the contract with the new vendor. The almost $34 million spent on this contract
annually as well as the potential liability to the state if adequate care is not provided justify
adding this position. This individual should be a state employee and should NOT be paid by the
vendor as provided for in Wexford’s contract (Section IX.1.4). The position may well pay for
itself if the financial penalties for staffing vacancies and other areas of non-compliance are
actually tracked and assessed.
Central New Mexico Correctional Facility – Dr. Spencer’s Report
Plant and Equipment:
We inspected the health care units in the Main facility and in the LTCU-MHTC facility (Long
Term Care Unit – Mental Health Treatment Center). They were clean and well-equipped, with
adequate examining and treatment space. There is an excellent physical therapy unit, a 4 chair
dialysis unit, two radiology units, and three negative pressure rooms. There are currently six
patients receiving dialysis. The drug room in the LTCU has a state-of-the-art Pyxis program, a
computerized medication stock monitoring system. This is not yet available in the Main facility,
but it would be desirable to have it there, too. I was told that there is also a need for more
computers, vital sign monitors, and IV pumps.
There are two telemedicine rooms. One is in the MHTC and is used for psychiatry consultations
with Dr. Gerson from other sites in the state. The other telemedicine room is used for the
Hepatitis C weekly presentations, involving Dr. Sanjeev Arora, Professor of Gastroenterology at
UNM.
The health-care unit at the Main facility has 4 examining rooms plus an emergency room. There
are also several adjacent observation cells, none of which were occupied at the time of my visit.
These may be used by custody or medical, but only for very brief periods of observation, and not
for suicide watch or critically ill patients.
There are three trailers, for geriatric housing, with a total of 42 beds. We visited one of these and
found it to be a far less than satisfactory housing arrangement for anyone, particularly elderly
man. It was dark and gloomy, crowded and in need of repair. The floor was especially in poor
condition.

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

18

Staffing:
An atmosphere of mutual regard and friendliness is apparent in the health care staff at CNMCF
and I had the pleasure of being assisted by some very capable staff. Particularly helpful was the
Director of Nursing who clearly is highly competent in her leadership role, and has the respect of
her team members. She has been working at CNMCF for five years, and as DON for the past 10
months.
Some of the provider staff (physicians, dentists and physician assistants) have also been at
CNMCF for a considerable period of time: Dr. Featherstone from 2002-03 and again since
November 2005 at 0.6 FTE; Dr. Scharf (psychiatrist) since January 2003 at 0.25 FTE; and Dr.
Ludwig (dentist) since September 2001 at 0.2 FTE. The other eight providers, on the other hand,
have been here less than 18 months. This suggests a problem with retention of provider staff.
There is only one clerical position for all the health care units. This is clearly inadequate.
Apparently the number of RN positions was significantly reduced with the Wexford contract,
and this should be re-evaluated.
Reportedly staffing was extremely low last summer. Therefore Wexford hired a recruiter to
remain here in New Mexico and that person was successful in filling many vacancies. That
recruiter however left New Mexico in September, and recruiting is again being done from the
Pittsburgh home office.
Intake Procedures:
A PPD skin test is done on the arrival date and blood is drawn for a CBC, CMP, RPR, and
Hepatitis B antibody, also HIV and Hepatitis C tests if agreed to by the inmate. Two-stage PPD
testing is done, the second test taking place about two weeks later. Laboratory services are
provided by SED Labs in Albuquerque, a courier picking up specimens on a daily basis.
Dipstick urinalysis, stool for occult blood, and glucometer testing are the only laboratory
procedures done on site. X-rays are developed on site, looked at by the providers, and then
shipped to a radiology group in Texas for a definitive reading.
Dental Care:
The dental operatory is spacious and tidy, has 3 chairs, a laboratory and an office. Monday,
Wednesday and Thursdays are reserved for RDC inmates, initial examinations in those mornings
and return visits for treatment in the afternoons. Dental sick call is conducted on Tuesdays and
averages 15 to 20 patients. A review of the appointment book with Dr. Jackson showed the
average wait time for non-urgent sick call is no more than one week, with follow-up visits about
2 weeks later. Fridays are reserved for patients in segregation units.
Sick Call:
Sick call is held five days a week, twice a day at the Main facility and once a day at the other
areas. Sick call request boxes are emptied each night at midnight, and those patients are seen the
following morning. They are not called out from their housing units, but simply show up and are
seen.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

19

Pharmacy and Medication Distribution
Medication distribution is via the pill call window at the Main facility and an effort is made to
prescribe on a b.i.d. basis. There is a k.o.p. (keep on person) policy except for the MHTC and
for controlled or psychotropic medication. Medications are supplied by a remote pharmacy in
Boswell, Pennsylvania. Stock medications are apparently adequate for starter purposes, until the
blister packs arrive from Boswell. A contract pharmacistcomes in monthly to do audits and drug
room inspections. Pharmacy and therapeutics committee meetings are held quarterly.
Chronic Illness Care
Oversight of chronic care scheduling at the Main facility is the responsibility of one LPN and
this is commendable. However he does not have consistent access to the computer, so does most
of the scheduling manually. Every week or two he and the charge nurse update the tracking
system spreadsheet on the computer. (In contrast, at the Level 2 facility and the MHTC health
care staff have daily access to the computer spread sheet and enter information daily.) Each day
that a chronic illness patient is seen, the LPN books him for the next appointment. Reportedly
the intent was to have the chronic care registry accessible throughout the state, but this is not yet
happened. The main use of the tracking system spreadsheet is to discover appointments that have
been missed and reschedule them. A copy of the updated tracking system list is also used by the
NMCD Medical Records Manager, who assembles such lists from all facilities monthly and
forwards them electronically to the central office in Santa Fe. It is not clear that these lists of
names with their diagnoses are put to any use at the central office. However, the total numbers
seen at the various clinics are tabulated and reported on the monthly statistical report sent from
each facility to the central office.
Chronic illness patients are seen all days of the week, except for HCV (Hepatitis C virus)
patients on treatment, who are seen by one designated PA monthly. He is also the one who
presents HCV patients (at the Main) to the weekly TRC (Treatment and Review Committee)
meetings. There is one designated nurse, who sees the HCV patients weekly to give them their
injections. The NMCD medical records manager maintains the HCV data base. She compiles
this from all sites and sources, even from SED lab.
I selected records at the Main from the chronic care tracking system list for my review. This list
seemed to be reasonably up-to-date, in light of the above comment about the periodic entries
from manual records. However many of the entries did not have specific diagnoses, and as noted
at LCCF, the diagnosis of diabetes insipidus was entered instead of diabetes mellitus. This error
should be easily correctable.
The records of six patients with diabetes were reviewed. A careful examination of the feet was
documented on the CCC (Chronic Care Clinic) visits for only one of these patients. Although
this is a standard requirement, the encounter form used does not specify this. An annual test for
microalbuminuria had been done on four of these patients. Five patients were appropriately
receiving an ACE inhibitor, but only one was receiving daily aspirin. Annual urinalysis and
annual funduscopic examination were not done on three patients. In two patients, no
electrocardiogram could be found. These patients were on oral hypoglycemic agents and their
blood sugar control was good. Of the four patients receiving insulin, control was satisfactory in
three only. Blood pressure was at the desired level of less than 130/80 in three of the six patients.
There was no evidence that any of these patients had received diet counseling, and my inquiries
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

20

led me to believe that dietitian services at CNMCF do not include patient counseling. Only one
of these six patients has received Pneumovax (pneumonia vaccine). Although this is a standard
recommendation at the national level, it is not included in Wexford’s chronic care guidelines.
The records of seven patients with hypertension were reviewed. Four of these had not received a
baseline chest x-ray. No electrocardiogram had been done on two of the patients. An annual
urinalysis was lacking in three patients. Blood pressure was controlled at the desired level of less
than 140/90 in only four of the seven patients. There was documentation of patient education in
only one of these patients.
The records of two patients with epilepsy were reviewed. Seizures were controlled in both cases.
One of them had not been restricted to a lower bunk. Drug levels had appropriately been tested
in both cases. One record did not have the diagnosis on the problem list.
Records of three patients with asthma were requested for review. One of these was at another
facility and one of them did not have asthma, so only one was actually reviewed. He lacked a
baseline chest x-ray, and peak expiratory flow rate was not repeated at each chronic care visit.
He had not received Pneumovax, although this is standard recommendation for such cases.
Records of two patients with Hepatitis C infection were reviewed. One of them was receiving
treatment and the other not. Care was appropriate in both cases.
There are only eight HIV infected patients in the entire CNMCF facility, and all are on treatment.
I did not review their records. Dr. Steve Jenison comes to the facility as needed and manages
their care.
Infirmary Care
I spent some time in the LTCU interviewing Dr. Harvey Featherstone and reviewing some
records with [Wexford staff]. Dr. Featherstone is a board- certified internist and attends here at
the LTCU Wednesday Thursday and Friday of each week. There has been some recent turnover
and changes in physician staffing here, resulting in a considerable variation in the coverage of
the first two days of the week. However, beginning next week Dr. Featherstone and Dr. Mizell
will be alternating five-day week coverage. Dr. Featherstone said there has been a marked
improvement in the past eight or nine months regarding off- formulary drug prescription. He
also was pleased with improvements in the collegial review process, saying it is now rare to have
any denials.
Although there is no methadone maintenance program in the NMCD, methadone can be given
here at the LTCU for pain.
The LTCU has 35 beds, can house women as well as men. Patients are categorized as acute,
regular housing, and permanent housing. Physician requirements are for daily rounds on the
acute patients, weekly on the regular housing and monthly on the permanent housing patients.
Admission history and physical examination are to be done within 24 hours or the next working
day. Nursing requirements are for nursing notes every shift, including vital signs, on the acute
patients, twice a week on regular housing and permanent housing patients. The charge nurse
recently resigned, and there were two agency nurses covering the unit. The nurses work 12 hour
shifts.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

21

There were six acute level patients at the time of my visit. These included a woman with
carcinoma of the esophagus receiving chemotherapy, a man who just received a total hip
replacement, a man recovering from self-inflicted injuries, a man who was post-op laparoscopic
cholecystectomy, a man who recently was discharged from the hospital following myocardial
infarction and stent placement, and another man with an abscess on his arm. I reviewed these
records and found care to be appropriate in each case.
Death Reviews
Mortality reports, autopsy reports and medical records of 13 deaths that occurred within the past
18 months were reviewed. I was pleased to read the honesty of the report and recommendations
for improvement, regarding a death that occurred during the Thanksgiving weekend of last year.
The report was done by the CNMCF Medical Director. This death apparently was a wake-up call
regarding weekend coverage of patients discharged from the hospital.
Hepatitis C virus screening and treatment:
The NMCD Hepatitis C program policy and procedure, # H-01 states that as many as 35 to 40%
of the prison population in United States are infected with HCV. This is lower than the 40 to
60% nationwide prevalence usually stated. A review of the available data regarding HCV
screening, prevalence, and treatment shows that of the average daily population of the NMCD of
6800, only 1589, or 23%, are HCV infected. Of those identified as HCV positive, only 24, or
1.5% are receiving treatment. These figures seem low in comparison with national data.
CDC recommendations are that all inmates should be questioned regarding risk factors for HCV
infection during entry medical examinations, and those with risk factors should be tested for
HCV. However, the NMCD policy states that “All inmates who request HCV screening will
have an ALT (a liver function test) drawn, if not already done. (It is not clear whether this policy
is followed, or whether an HCV test is done at intake on inmate request.) If the ALT is elevated
it will be redrawn in two months, and if it is again elevated, an HCV test (ELISA) will be
drawn.”
This is the beginning of an extensive and complicated series of tests and barriers presented to the
inmates before they can be considered for treatment. Those who finally make it through the
complex screening procedure (1.5% of those infected) are presented to the TRC (Treatment
Review Committee) weekly conferences, chaired by a recognized HCV Authority at UNM.
The ECHO program is a federally funded statewide HCV screening and treatment program, and
includes qualified medical expert participation. However, the screening procedure is very
extensive and time consuming, and the eligibility criteria for treatment are quite strict. As a
result, very few of those infected are receiving treatment. Since there seems to be a significant
discrepancy between the New Mexico and the national data, I recommend that the HCV policy
be reviewed and revised, if necessary, and finally endorsed and signed off by the UNM authority,
to make sure that quality of care, rather than cost considerations, are driving the selection
decisions.
Conclusion:
The following matters are deserving of attention at CNMCF:
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

22

•

The geriatric housing trailers are a counter-therapeutic environment, and should be
replaced.

•

There is only one clerical staff position authorized. This is grossly inadequate, and results
in nursing staff having to perform clerical duties, when their time should be more
appropriately used. Several additional clerical positions are needed.

•

Additional computer posts are needed.

•

The excellent Pyxis medication program and equipment should be available throughout
the health care system.

•

There may be other equipment needs, and the nursing and provider staff should be
surveyed regarding this matter.

•

The Chronic Care Tracking System has limited practical value. Its usefulness could be
improved with better computer access for the staff responsible for scheduling
appointments. In addition, many of the patient entries are lacking a diagnosis, and the
diagnosis of diabetes mellitus is erroneously entered as diabetes insipidus.

•

Patients with diabetes need improvement in their care and in their standard of care. They
should receive Pneumovax (pneumonia vaccine); their blood pressures are not well
controlled; they should receive prophylactic aspirin; they should routinely have a careful
examination of their feet; they should have an annual eye examination; they should
receive a diabetic diet, and dietary counseling should be provided.

•

Patients with hypertension should have a baseline chest x-ray and electrocardiogram, and
an annual urinalysis. There should be documentation of patient education for these and all
chronic illness patients, but this is lacking.

•

Patients with asthma should receive Pneumovax, and should have peak expiratory flow
measured at each of their quarterly visits.

•

These many deficiencies in the care of chronically ill patients are probably due largely to
insufficient reminders on the forms that are in use. Wexford’s Chronic Care Guidelines
are satisfactory, except for the absence of Pneumovax. Their disease-specific flow sheets
serve as useful reminders to the provider for what needs to be done. However, the
Wexford flow sheets are not being used. Instead, a generic NMCD chronic care
encounter form is used. This form has only a very few disease-specific reminders listed
on a side bar, and no flow sheets are used.
The care of chronically ill patients would be greatly improved if adequate encounter
forms and flow sheets were to take priority over printing and paper costs.

•

The complicated screening and selection process for eligibility for treatment of Hepatitis
C needs to be reviewed. An infection prevalence of only 23% may not compare
convincingly with national data.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

23

Penitentiary of New Mexico – Dr. Spencer’s Report
Plant and Equipment
The Penitentiary of New Mexico is a complex of three prison facilities with a total average daily
population of approximately 900. The level II facility has a population of 320, and levels V and
VI have 288 each. The level II facility is a minimum restrict unit, and its clinic space is far too
small and crowded. Levels V and VI are maximum-security units, and their clinic space is
adequate. The level VI facility occupants are generally long-term, whereas level V has frequent
turnover. At level II all patients are seen in the clinic, for nurse or provider sick call. In levels
five and six nurse sick call is conducted in small examining rooms in the housing units. I visited
once such room and found it entirely adequate.
There is an automated external defibrillator (AED) in each housing unit in levels V and VI and in
the medical units of all three facilities. There is one radiology unit for all three facilities, located
in the level VI facility. There is also one optometry unit for all three, located in the level V
facility. In the level VI facility there is also a telemedicine unit, which is used for the statewide
TRC (Hepatitis C) weekly conferences, presided over by Dr. Breen. There are glucometers and
peak flow meters at each facility clinic. The medical unit in level VI also has a “crisis room”
used for suicide watch.
There is a need for more computer terminals and access to a centralized medical information
system; the need for such a network is obvious.
Staffing:
Staffing is marginally adequate at best. There is a need for more dentist time, optometrist time,
another clerical position, and more LPN’s.
There are some staff vacancies such as the medical records position and the charge nurse
position at the level II facility.
Sick Call
In the level II facility, the inmates place their sick call requests in locked boxes in the hall. The
nurse picks these up every evening Monday through Friday. (There is no medical staffing here
on weekends.) Sick call is held in the medical unit in level II. In the level V and VI units sick
call requests are handed to the nurse at the time of medication distribution. The requests are
triaged and booked for either the next nurse sick call or the next provider sick call (mid-level or
physician). No log is kept to reflect timeliness of sick call response, but I was assured that all
inmates are seen at the next sick call, that no backlog occurs.
Pharmacy and Medication Distribution:
At the level II facility the inmates come to the pill window to receive their medications. No
patients here are on narcotics and there are no diabetics who receive insulin at this facility, either.
There is a keep-on-person policy except for psychotropic medications.

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

24

In the level V and level VI facility, the nurses take medication carts to the housing units. It is
during these medication rounds that they may be given sick call requests directly from the
inmates, and as noted above, conduct sick call in special examining rooms at each housing unit.
Chronic Illness Care:
There is a commendable effort at PNM to make full use of the chronic care tracking sheets.
Associated chronic disease diagnoses are entered, along with date last seen, date of next
appointment and actual date seen. Dr. Breen has a special interest in Hepatitis C, and it is
significant that of the 24 patients in the entire state system that are under treatment for Hepatitis
C, 10 are located at PNM. This may be pure chance, or it may reflect a more conscientious effort
to move these patients into the treatment protocol.
I selected records from the chronic care tracking list at level V and level VI. These included four
patients with diabetes. On only one of these patients was a careful foot examination done at each
visit. An annual electrocardiogram was done on only one patient. An annual urinalysis was
done on only two of the four. An annual funduscopic examination was lacking in three of the
four. Blood sugar control is fair to good in two of the four. Blood pressure was at the desirable
level in only two of the four. One patient with microalbuminuria was not receiving an ACE
inhibitor as he should have been. Only one of the four patients was receiving prophylactic
aspirin. One of these patients, who transferred from SNMCF in January had received
Pneumovax while there. I was told that Pneumovax is not given at PNM. I was also told that
there is no dietary counseling from a dietitian at PNM. These are clear deficiencies in care. The
diabetic diet has also been inadequate. I reviewed the diet list provided by the Aramark food
service contractor. The usual diet for diabetics has been, “No Concentrated Sugars.” Only very
recently has an effort been started to prescribe an ADA diet of specified caloric value.
Records of six patients with hypertension were reviewed. An annual urinalysis was lacking in
four of them. In only one of them was the blood pressure controlled at the desired level of
140/90 or less. Documentation of patient education was lacking in two of these patients.
The records of three patients with epilepsy were reviewed. No significant deficiencies were
found in the care of these patients. The diagnosis was not mentioned on the problem list in one
of them, and presence or absence of signs or symptoms of drug toxicity was not documented in
two of them.
The records of six patients with asthma were reviewed. One of these patients did not have peak
expiratory flow rate measured at each visit. Two of the group had not had a chest x-ray.
Although Pneumovax is a standard recommendation for patients with asthma, only two of this
group had received it, and one of them was a recent transfer from SNMCF. Annual influenza
vaccine was also lacking in three of these patients.
The records of two patients with Hepatitis C infection were reviewed, and their care was
appropriate.
Dental Care
As noted above, the dentist hours are inadequate. There is a dentist, 20 hours a week for all of
PNM. He comes in Monday and Saturday for 10 hours each day. At the present he has no
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

25

assistant. There is a dental operatory at level V and another level VI. The dental records at level
VI show that he sees 10 to 12 patients each day that he is here, and there are 53 on the waiting
list. That waiting list may be unreliable however. The HSA reviewed and counted the number
of dental sick call requests at both level V and level VI. At level V there was 1 from December, 1
from January, 9 from February and 6 from March. These were sick call requests from inmates
that had not yet been seen by the dentist. At level VI there were 3 from November, 9 from
December, 15 from January, and the ones submitted since then could not be located. It is clear
that not only is there insufficient dental time on-site, but also that the record keeping regarding
the waiting list is unreliable. I was told that the inmates no longer submit any sick call requests
for dental care unless they have a very serious problem or a toothache, since they know that the
chances are they will not be seen for many months.
Optometry Services.
The situation for optometry is even worse than that for dental care. Unfortunately, no
spreadsheets or logs are maintained for dental or optometry services that would show the date of
request and the date seen. Likewise, the waiting list information is equally unreliable for
optometry as for dental care. The optometrist provides 16 hours of service per month for the
entire PNM complex. He does this by coming in every other Tuesday, rotating among the
patient group at level II, V, VI, and the Santa Fe County Jail. As a result, he is able to see about
10 patients at any one facility every two months. All patients are seen at the optometry unit in
level V. There are currently 71 patients on the optometry waiting list for level V and level VI. I
was informed that the inmates are being told that there is about a one year wait to be seen by the
optometrist. I was also told the Dr. Breen intends to send diabetics off-site for their annual
funduscopic examinations, since these are not been done in the required timely fashion.
There is clearly a need for much more optometry time.
Off-site Care:
As previously mentioned, “collegial review” phone conferences are held twice a week. Dr. Breen
attends and referees these, along with the corporate quality assurance medical director. I
reviewed the PNM medical transport calendars for January, February and March of this year.
They show 8 transports for off-site specialty care for January, 9 for February and 13 scheduled
for March. I have no way of judging appropriate timeliness of these off-site services from the
information I have reviewed.
Grievances:
I was provided with the health-care grievances for January, February and March of this year. The
grievance log records the date of grievance and date of response, the nature of the grievance and
nature of the response, and the category of the grievance. To my great surprise, there was only
one grievance in January, three in February and one so far in March. Only one of these
grievances concerned dental care, and the response included the statement that there is a backlog
of 89 inmates waiting for dental service.

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Conclusion:
The following matters are deserving of attention at PNM:
•

Clinic space at level 2 is far too small and crowded.

•

There is a need for more computer terminals and access to a centralized medical
information network for the entire prison system.

•

Staffing is marginally adequate at best, with a need for more LPN’s, another clerical
position, and a serious need for more dentist time and optometrist time.

•

There are currently some vacancies in important positions.

•

There is a need for reliable logs to be kept for recording the timeliness of responses to
sick call requests, off-site consultation requests, dental and optometry requests. The
current record-keeping for these is clearly inadequate and unreliable.

•

The care of diabetic patients does not meet national standards. As mentioned previously,
the Wexford chronic care guidelines and flow sheets would be an improvement over the
forms put in place by NMCD. The current one-size-fits-all encounter forms lack
important reminders, and as a result, many deficiencies in care are occurring. These
include a failure to give ACE inhibitors when indicated, a failure to provide prophylactic
aspirin, a failure to give Pneumovax, a failure to perform a careful foot examination on
each visit, and a failure to have an annual funduscopic examination performed by an eye
specialist. Blood pressure is not controlled to the desirable level, nor is blood sugar
adequately controlled.

•

Pneumovax (pneumonia vaccine) should be provided to diabetics and to those with
chronic respiratory problems such as asthma.

•

Dietitian counseling should be available to patients for whom it is indicated, including
diabetics.

•

Appropriate ADA diets for diabetic patients should be ordered and available.

•

Patient education should be done and documented on chronic illness visits.

•

Patients taking antiepileptic drugs should be examined for presence of signs or symptoms
of drug toxicity.

•

Annual influenza vaccine should be given to all patients with chronic respiratory
problems.

•

Dental services are grossly insufficient.

•

Optometry services are grossly insufficient.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

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•

Pending adequate on-site services, diabetic patients should be sent off-site to
ophthalmologists for their annual dilated funduscopic examinations.

New Mexico Women’s Correctional Facility – Dr. Spencer’s Report
The population of this facility on this date is 584. This consists of the following units: Unit A,
(RDC) 78 inmates; Unit B, (TCU) 80 inmates; Unit G, approximately 286; Unit F-1 special
needs inmates approximately 10, faith-based inmates approximately 10; Unit, F-2 about 20 beds
(minimal custody); SHU (segregation), about 14; Diagnostic unit, five cells adjacent to the
mental health unit.
Plant and Equipment:
Space is barely adequate, with one “emergency room” that is used for sick call encounters, the
physician’s office and PA’s office, each of which is also an examining room. There is also some
new telemedicine equipment, which is used for psychiatry encounters twice a week. Dr. Nelson
and Dr. Kowalkowski each has his own caseload, and they interview their patients without any
other staff present. The plan is to use telemedicine also for the TRC conferences.
There is no infirmary here; patients needing that level of care are sent to CNMCF. High-risk
patients are housed in the cells adjacent to the mental health unit. There are five such cells with
open visibility. At the time of my visit, one was occupied, with one officer conducting constant
suicide watch.
There is no x-ray equipment on site. A portable x-ray is brought in as needed.
Staffing:
The Health Services Administrator, is deserving of recognition for the excellent job she is doing,
as well as for the help she provided to me. The physician, Dr. Gibson, and the PA are also to be
commended for their clinical skills, as reflected in the medical records I reviewed.
Authorized staffing positions are not adequate. There is a need for more nursing and clerical
positions. It is clear is that nurses are spending time performing clerical functions that should be
fulfilled by clerks. Further complicating the situation are several vacancies. For example, the
dental hygienist position has been vacant for several months.
There is one full-time physician, and one full-time physician’s assistant. There is no consulting
dietitian to advise patients. There is no physical therapist. Optometry and ophthalmology
services are off-site. Pregnant patients are seen by a local family practitioner. While there are
two family practitioners in Grants that deliver patients, one of them refuses to see inmates.
There is no board-certified obstetrician available in Grants.
A review of the monthly health services report shows that there is no differentiation between
patients seen by the physician, the physician’s assistant, or the nurse. It is suggested that the
category of provider be specified in these statistical reports.

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Intake Screening:
There are 30 to 40 intakes per month. Two-stage PPD testing is appropriately done here. The
practice is to read the first stage PPD at 72 hours, return the patient 14 to 30 days later and plant
the second stage, reading that at 72 hours later. This is certainly acceptable, but involves one
more nursing encounter than is necessary. A significant reaction to the first stage will almost
always still be apparent at one week, so the first stage can be read at that time and the second
stage planted at the same visit.
Routine laboratory tests done at intake consist of a CBC, comprehensive metabolic panel (CMP),
lipids, RPR, Hepatitis B core antibody, HIV test if consented to, urinalysis and HCG. Routine
immunizations consist of Hepatitis B vaccine, if indicated by the antibody tests, and tetanusdiphtheria vaccine if indicated. MMR vaccine (Measles, Mumps, Rubella) is not offered.
According to the CDC adult vaccine recommendations, MMR should be given to all women of
childbearing age who are not currently pregnant, unless they have evidence of Rubella immunity.
The initial health assessment is reportedly done within seven days, as policy dictates. The forms
and the chart reviews indicate that this is a good comprehensive history and physical
examination. These are done by the Physician Assistant.
The only computerized spreadsheet that records intake information is a complex one, updated at
the time of physical examination, but including annual physical examination dates, with columns
for incarceration date, physical examination, Pap smear, PPD, Hepatitis B status, and
mammogram. There is a need for a spreadsheet that reflects only the timeliness of intake
procedures. This would be useful for CQI review purposes.
Emergency and Hospital Care:
The Mount Taylor ambulance service is promptly available. Patients are taken to Cibola General
hospital for emergency and primary care admissions. More complex cases are referred to
Lovelace Hospital in Albuquerque.
Sick Call:
Sick call is conducted five days a week. For the RDC and segregation inmates, sick call requests
are picked up by the nurses at the time of medication distribution. For general population
inmates, they can slip their sick call requests into a pharmacy window at any time, or just come
to the clinic and sign up and wait to be seen. There is also an opportunity every day during the
lunch hour for inmates to sign up for sick call, as a desk in the dining hall is staffed by health
services for one hour each day. A registered nurse triages all requests, and reportedly all those
who need an encounter with health care staff are seen the same day. There is no log that reflects
timeliness of sick call requests and encounters, but it seems clear that access to care is
appropriate. However, for purposes of CQI review it would be desirable if a log were kept
reflecting the times of receipt of sick call requests, and the times these were fulfilled by patient
encounters.

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Specialty Care:
Diabetic eye examinations are referred to an ophthalmologist in Albuquerque, following
approval by the collegial review committee. There has been no problem in getting these done.
There is an optometrist in Grants, who sees patients for refraction and prescription for glasses.
Six patients are sent to him at a time, at least twice a month. I reviewed the off-site schedule and
collegial review presentation records, but was not able to make any judgments regarding
timeliness of this process, since there is no coordinated or combined spreadsheet covering this
activity. The medical director feels that there is no difficulty with the collegial review process,
that she gets approval for the off-site services that she requests.
Dental Care:
The dental operatory has two chairs. There is a dental assistant at only 0.5 FTE. There are two
dentists, each coming one day a week. One comes on Wednesday for 10 hours and sees only the
RDC inmates, performing a charted dental examination, a Panorex film, and bite-wing x-rays as
indicated. The other dentist comes for 12 hours on Fridays and sees those who need care. It is
clear that more dental service is needed. Currently the backlog for dental care is approximately
130 patients. It was over 200 last September, but since then a second dentist has been coming on
site and the backlog has been reduced to 130.
Mental Health Care:
Dr. Pierre Rouzaud is the regional director of psychiatry, and comes on site twice a month to see
high-risk patients. There are two other psychiatrists at remote locations in Illinois and
Massachusetts. They see each of their patients by telemedicine, every one to three months. They
also come on site twice a year. The telemedicine encounters are with only the patients, without
accompaniment by mental-health caseworkers.
Non-psychiatric mental health care is provided not by Wexford, but by Forensic Health Services
(FHS). I spoke with the Mental Health Director. He has a staff of 10 clinicians plus
administrative staff and one test proctor. These clinicians do the 60 day diagnostic and
evaluations (D&Es) for the women intakes, as well as their mental health caseload. The MH
Director makes every effort to insure that those clinicians who have done a D&E are not
subsequently providing mental health services to those same inmates.
There is a multidisciplinary team (MDT) which meets weekly to discuss medical, mental health,
or security issues. This team includes custody representatives, but the custody staff members are
ones with senior experience. There is no mental-health housing unit at this facility.
Pharmacy and Medication Distribution:
There are three medication passes per day at the pharmacy pill window. There is a keep on
person policy for general population. This is a standard k.o.p. policy that excludes psychotropic
medications, which are all crushed and administered at the pharmacy window. Patients in RDC
and segregation have their medications delivered to them three times a day, by medication cart.
Medications are in standard blister packs. There are stock medications in the pharmacy. A
consulting pharmacist inspects the unit monthly, and I viewed his reports.
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Infectious Disease Surveillance:
There are currently five patients on prophylactic INH for TB infection. There is only one case of
HIV on treatment. There are three cases of Hepatitis C virus under treatment. Cases of MRSA
have been carefully tracked, and currently there are none under treatment.
There is no designated Hepatitis C coordinator, so that task of tracking and scheduling is carried
out by the Medical Director, who is also the one who presents the cases at the TRC
teleconferences.
Chronic Illness Care:
Chronic Illness patients are mostly seen by Dr. Gibson. Cases were selected from the Chronic
Care Tracking System, which was last updated two weeks earlier. The records of 7 patients with
diabetes were reviewed. Careful examination of the feet for circulation, sensation and infection is
a standard of care, and was documented in 5 of the cases. A baseline and annual
electrocardiogram was lacking in 4 patients. Only 2 of the group had annual urinalyses and tests
for microalbuminuria. Five of the 7 had received an annual funduscopic examination by a
specialist. Blood sugar was satisfactorily controlled in all but one. Blood pressure was at or
below the desired level of 130/80 in all but one patient. An ACE inhibitor was prescribed where
indicated in all but one patient, but recommended aspirin was not given to 5 of the group.
Pneumovax had been given to only one of the 7 diabetics, and annual influenza vaccine was
documented in only one. However, Dr. Gibson is analyzing the reports on last season’s influenza
vaccine administration, and that data has not yet been entered into the medical charts, so
presumably it was given to more than one of this group of 7 diabetics.
Records of seven patients with hypertension were reviewed. A chest x-ray was lacking in all but
one. Baseline and annual EKG were done in only two of the cases. An annual urinalysis was
lacking in four cases. The blood pressure was satisfactorily controlled in all but one case, and
that was a patient with diabetes.
The records of 8 patients with asthma were reviewed. Peak expiratory flow rate was faithfully
tested at each visit in all of these patients. A chest x-ray had been done on only one of the group.
None of the eight had received Pneumovax. Documentation of annual influenza vaccine was
missing in all of the group, but that may be due to the factor cited above with the diabetics.
The records of three patients with seizure disorder were reviewed. Blood counts and drug levels
had been ordered appropriately in all three. Seizures were controlled in all three, and they had
all been restricted to a lower bunk.
The records of the three pregnant patients were reviewed, and their care has been appropriate.
Continuous Quality Improvement (CQI) Program:
Minutes of the monthly staff meetings were reviewed, and these include CQI reports. Sample
auditing tools were also reviewed. Staff does the auditing, some aspects of care on a monthly
basis, others quarterly.

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Grievances:
Last October, a unit management system was put in place by CCA. There are two unit managers
with about 300 inmates each, and the team for each manager consists of counselors, case
managers and caseworkers. The counselors are correctional officers. Informal complaints are
presented in writing and are sent to the appropriate staff member, the HSA if it is a medical
grievance. A response in writing is returned to the unit management team, and if the matter is
not thereby resolved, the inmate files a formal grievance. Records are kept only of the formal
grievances. I reviewed the monthly reports of these. There were only nine in September, none in
October, one in November, none in December, and only one in January.
Conclusion:
The following matters are deserving of attention at NMWCF:
•

Space is barely adequate, with the doctor’s and PA’s offices having to double as
examining rooms. A couple of dedicated examining rooms would be desirable.

•

Authorized staffing positions are not sufficient. There is a need for more nursing
positions. The situation is further complicated by the existence of several vacancies. The
physician should not have to be the one serving as Hepatitis C coordinator. This
responsibility should be assigned to a nurse.

•

Physical therapy services should be provided on-site.

•

It is recommended that the monthly health services reports reflect the number of patients
seen by the physician and the number seen by the physician’s assistant, rather than
lumping them together in one total figure.

•

It is suggested that the reading of the first stage PPD and the planting of the second stage
be done at the same visit, one week after planting the first stage. This would eliminate
one nursing encounter.

•

It is recommended that one nurse be assigned responsibility of Hepatitis C coordinator.

•

It is recommended that MMR vaccine be offered to all women of childbearing age who
are not pregnant and who do not have proof of immunity to rubella.

•

There should be a spreadsheet that records the timeliness of the intake procedures, and
does not combine this with the information regarding the annual physical examinations.

•

There should also be a spreadsheet or log for sick call, reflecting the date of receipt of
sick call requests, the date seen, by whom seen, and the disposition of the case.

•

As recommended at other facilities, it would be highly desirable if there were a
spreadsheet or log maintained regarding the off-site referral process, reflecting the date of
request, the decision of the collegial review presentation, the date an appointment was
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made and the date the patient was actually seen. Without this, a significant CQI review
cannot be conducted.
•

There is clearly a need for more hours of dental service. The current backlog of 130
patients waiting to be seen is unacceptable.

•

The care of chronically ill patients, while timely and conscientious, fails to comply with
nationally accepted clinical guidelines. These guidelines are reproduced in the Wexford
chronic care guidelines, except that Wexford failed to include Pneumovax for diabetes
patients. Review of the medical records of a sample of chronically ill patients shows that
Pneumovax has not been given to any of the patients with diabetes or asthma.
Electrocardiograms, chest x-rays, urinalyses, tests for microalbuminuria, prophylactic
aspirin, and careful examination of the feet were all frequently lacking when indicated.
As mentioned earlier, these deficiencies would not be likely to occur, if flow sheets and
forms with guideline reminders on them were utilized in place of the ones currently in
use.

•

Dietitian counseling services should be available to patients when needed.

Western New Mexico Correctional Facility – Dr. Spencer’s Report
The average daily population of this facility is approximately 400, housing classification levels
2, 3, and 4. Monthly statistical health services reports were reviewed. They are completed
faithfully by the Administrative Assistant. In recent months, a weekly statistical report has also
been prepared.
Plant and Equipment
This is an excellent clinic facility with plenty of space, a large emergency room and two
examining rooms. There are four isolation rooms for suicide watch or short-term observation,
and an additional room with a restraint bed. None of these were occupied at the time of my visit.
The ER contains an electrocardiogram and a crash cart with monitor/defibrillator. AEDs have
been purchased for the facility, but the training has not been done yet.
There is a dedicated telemedicine room used for psychiatry and the TRC meetings. The
telemedicine equipment was provided by the ECHO program. There is a small laboratory room
for performing dipstick urinalyses and centrifuging blood. Blood specimens are sent to SED
Labs. Glucometer testing is done at the pharmacy pill window.
There is an x-ray room. A technician comes in once a week, and the films are shipped to a
radiology group in Texas. Radiology safety inspection certificate is current.
There is an optometry room, and the optometrist who comes in does the diabetic eye exams.
The dental clinic is a two chair operatory. There is a separate Panorex room.

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Staffing:
The physician, Donald Horney M.D., attends here Monday and Thursday for 10 hours each,
coming from Gallup, New Mexico. This is not sufficient physician time, since he has to spend a
significant amount of each of those days preparing for the TRC conference or the collegial
review conference. Additional physician time is recommended, so that he can see chronic care
patients as well.
The pharmacy is staffed 24 hours seven days a week, by pharmacy techs, who work12 hours
shifts, 7 a.m. to 7 p.m. The rest of the health care staff works five days a week, 8:00 to 4:30.
Emergency and Hospital Care:
Patients are taken to Cibola General Hospital for emergency and primary care. More complex
cases are then flown to the Lovelace Hospital in Albuquerque, after stabilization.
Sick Call:
There is a drop box for sick call requests in the clinic, accessible for the inmates on the
minimum-security side of the facility. For those in the segregation and lockdown units, the sick
call requests are given to the nurse at the time of medication distribution. Sick call requests are
triaged by the clinic coordinator, who then prepares the call out list of those to be seen, and the
nature of the request.
Dental Care
The dentist comes in one day a week. There is no longer a dental hygienist here. The dentist
sees about 14 patients a day including the annual examinations. There is no serious backlog of
patients waiting, with 42 on the wait list, 26 of whom are for cleaning (prophylaxis).
Chronic Illness Care:
The Hepatitis C files and data are very well-organized, the best I have seen in the state.
Chronic illness patients are seen by the PA, occasionally by the physician. Due to the lack of
familiarity with the Wexford chronic illness guidelines, and the inadequacy of the forms used for
this operation, care of these patients was found to be less than entirely satisfactory. Charts were
selected for review from the chronic care monitoring system, which is updated at each patient
encounter.
The medical records of six patients with diabetes were reviewed. There was a failure to perform
a careful examination of the feet for circulation, sensation and infection at each chronic care visit
in 5 of these patients. An annual electrocardiogram was done in only 3 of these patients. Five of
them had been appropriately tested for microalbuminuria, but only 2 had an annual urinalysis
done. They had all received their annual funduscopic examination. In 4 of the 6 the blood sugar
was not well controlled. The blood pressure was well controlled at or below the recommended
level of 130/80 in four of the six. An ACE inhibitor was being given to those for whom it was
indicated. Aspirin was appropriately given to all but one. Dietitian counseling is not available at
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Steven S. Spencer, MD and B. Jaye Anno, PhD

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this facility. Two of these patients had received Pneumovax, but none of the group had received
their last annual influenza vaccine.
The medical records of 3 patients with hypertension were reviewed. A baseline chest x-ray had
not been done in 2 of the 3, nor had a baseline EKG been done. An annual urinalysis was
lacking in 2 of the 3. Blood pressure was not well controlled in one of them. In one case, the
last chronic care visit was over 4 months previously, whereas these are supposed to occur
quarterly. Documentation of patient education was insufficient.
The medical records of 5 patients with asthma were reviewed. The peak expiratory flow rate had
been measured at each chronic care visit in all but one of these cases. A baseline chest x-ray had
been taken in only one of the five. None of the group had received Pneumovax or the last annual
influenza vaccine.
The medical records of 3 patients with seizure disorder were reviewed. Seizures were well
controlled in all 3, but in one case the patient was not being seen every three months. Drug
levels were not appropriately tested in one case. The presence or absence of signs or symptoms
of drug toxicity was not documented in 2 of the 3.
Pharmacy and Medication Distribution:
Patients come to the pharmacy pill window three times a day, except for the segregation and
lockdown units, where the nurse delivers medication to them. Glucometer testing is done at the
pill distribution point, and insulin is administered by the patients themselves under supervision.
Infection Control:
Reportedly, there were only six cases MRSA in the past year, and none currently. There are no
cases of Hepatitis C on treatment at this facility, since they are sent to CNMCF. Dr. Steve
Jenison comes in quarterly to see the HIV patients, of which there are three on treatment at the
present. There have been no cases of active tuberculosis in recent months, and there is no
negative pressure room in this facility. There are currently 14 patients taking prophylactic INH.
Continuous Quality Improvement Program:
I reviewed the quality management program minutes of the past few months, but there is
apparently very little CQI activity taking place. I was told that the Director of Nursing audits the
psychiatry and chronic care charts quarterly, but those studies were not available at this time.
Conclusion:
Although health-care operation that WNMCF is very efficiently run, the following matters
deserve attention:
•

There is a definite need for more physician hours, for seeing patients and for providing
clinical leadership in the chronic care program.

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•

There is a need for a dental hygienist. It would be more efficient and less expensive if a
hygienist were there to do the cleaning (prophylaxis), while the dentist does examinations
and treatments.

•

The care of chronic illness patients, fails to comply with national standards and Wexford
guidelines. As mentioned earlier, this problem would be largely corrected with the use of
more appropriate forms that include guideline reminders. The deficiencies are
particularly striking in the case of diabetics,

•

Pneumovax should be available, and provided to those chronic illness patients for whom
it is indicated.

•

Influenza vaccine should also be available for annual provision to those patients for
whom it is indicated.

•

Dietitian counseling should be available to patients for whom it is indicated, including
diabetics.

•

There is a need for much more significant CQI activity, with more frequent monitoring,
reporting, and remedial action.

Final Conclusions and Recommendations
The New Mexico Corrections Department and Wexford Health Services each have some highly
capable, conscientious and dedicated employees. A few of these whom we met are cited in our
report, but there are undoubtedly additional ones who deserve commendation. We want again to
express our gratitude to those who were so helpful to us and enabled us to do our work
efficiently and with pleasure. Our role, however, is not to identify individual employees for
praise or criticism, but to identify systemic problems and to make suggestions for corrective
action. We therefore offer the following comments, which are not presented in any order of
priority:
1.
There is an urgent need to fill the NMCD Medical Director position. This person’s
responsibilities should include providing clinical oversight of the contractor’s performance, and
attending the off-site referral (“collegial review”) meetings and the Hepatitis C Treatment
Review Committee (TRC) meetings.
2.
The NMCD-Wexford contract has some requirements that are not all being fulfilled at all
facilities. These include Wexford/NMCD meetings 10 times a year, quarterly Pharmacy and
Therapeutics Committee meetings, electronic medical records, and penalties for staffing
vacancies.
3.
The present contract does not provide adequate authorized staffing positions. There is
insufficient physician staffing at LCCF and WNMCF, insufficient dental staffing at LCCF,
PNM, NMWCF and CNMCF, insufficient optometry staffing at CNMCF and PNM, insufficient
clerical staffing at all facilities, and insufficient nursing (particularly RN) at all facilities.

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4.
Compounding the inadequacy of authorized positions is the vacancy rate. Wexford has
had difficulty with recruitment and retention, and reportedly the penalties for vacancies have not
been enforced.
5.
It is clear that there is a need for better systems for communication between NMCD and
Wexford, and for closer monitoring. We recommend that a health care monitoring position be
added to the NMCD Central Office staff. Additionally, there is a need for a computerized
medical information system, accessible at all facilities by NMCD and the contractor. This would
enable a much needed consistency in reporting, and would also provide system-wide access to
information regarding tracking of chronically ill patients, progress of the Hepatitis C treatment
screening procedure, timeliness of the off-site referral process, among other things.
6.
The Continuous Quality Improvement (CQI) program needs improvement in design and
implementation. It should clearly be a multidisciplinary effort and involve NMCD staff,
including the Warden or his representative, as well as the contractor’s health care staff. In
addition to carrying out the monitoring assignments of the corporate office, it should also
identify suspected site-specific problems, study and monitor them, implement corrective
measures, and evaluate subsequent outcome.
7.
There should be a standardized log or computer spread sheet for documenting the
components of the intake process, at RDC and NMWCF. This would make it easily possible to
monitor the timeliness of the various procedures. Our review of samples of charts at RDC
revealed that there are some failures to meet required time frames. Sampling charts is a very
cumbersome way to determine compliance. This information should be readily available for
routine CQI studies, from an activity log.
8.
Likewise, there should be a standardized log for documenting timeliness of the sick call
activity. There is a lack of consistency among the facilities in recording sick call requests for
time received, time of encounter, and disposition of case, i.e. whether referred to practitioner,
etc. This information also should be readily for routine CQI studies.
9.
The contract calls for sick call triage and screening encounter to be done by a RN or midlevel provider (PA or NP). In actuality these activities are being done mainly by LPNs. Several
of the Wexford Nursing Treatment Protocols are not appropriate for implementation by LPNs,
and it is essential that staffing provides that a RN (or a midlevel provider) is always on site when
sick call is being conducted, to be called upon for serious medical problems that exceed the
capability of the LPN.
10.
Although nurse sick call is held five days a week, inmates must have the opportunity
daily to request health care. (National Commission on Correctional Health Care standard.) A
nurse should collect and triage sick call requests daily, and this is not being done at LCCF.
11.
Sick call “no shows” should be re-scheduled, not dropped from the list. A “no show” may
be due to a variety of causes, some serious, and deserves follow-up.
12.
The chronic illness clinic program is unsatisfactory system-wide. The logs, or “Tracking
System” are inaccurate and incomplete. There are innumerable examples of failure to follow
nationally accepted guidelines, most of which are stated in the Wexford chronic care guidelines.
However, the forms that are in use are NMCD forms, and they are less than satisfactory.
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

37

Wexford’s forms are better, and include disease-specific flow sheets that have brief reminders of
the parameters to be followed. Such guideline reminders are essential in prison health care. The
system now in place does not allow for a significant CQI monitoring of chronic illness care,
because it lacks disease-specific criteria. This important aspect of care is not meeting quality
standards.
13.
Related to the chronic illness program is the fact that Pneumovax (pneumonia vaccine) is
not available to patients with diabetes or chronic respiratory conditions, and it should be
available.
14.
MMR (measles, mumps, rubella) vaccine should be offered to all women of child-bearing
age who are not pregnant and do not have proof of immunity to rubella. This is a CDC
recommendation that is not being followed.
15.
The off-site referral process needs better documentation. All components of this activity
should be recorded on the same spread sheet, not on separate sheets of paper, and should include
the denials, and the date of each step in the process. Although reportedly the “collegial review”
process is now more responsive to the attending physicians’ requests, there are still a significant
number of denials, and insufficient means of tracking and evaluating these denials. The NMCD
Medical Director should be able to attend the collegial review meetings, and at least should be
notified of the denials, so that he can investigate them as part of his oversight responsibility.
16.
Hobbs is a long distance from Albuquerque, where Wexford has identified its
consultants. This constitutes a disincentive for patients and staff when consultations are
recommended. Although Las Cruces is also distant, it is closer to Hobbs than Albuquerque, and
it is suggested that the contractor identify appropriate consultants there.
17.
The HIV screening and treatment program is operating very satisfactorily at the patient
care level, with an agreement between the NMCD and the New Mexico Department of Health.
However, the agreement requires the DOH to provide quarterly reports and an annual summary.
Our efforts to obtain these were not successful, so we wonder whether they in fact are being
provided.
18.
The Hepatitis C virus (HCV) program, on the other hand, raises some questions. The
UNM gastroenterologist who makes the clinical treatment recommendations is a nationally
recognized authority on HCV. However, the procedure for determining eligibility for treatment is
very cumbersome and lengthy, raising the question of whether he is being presented with all the
cases deserving of treatment. Enthusiasm for such treatment seems to vary among clinicians at
the several NMCD sites. Record keeping also varies, and the Clinic Nurse/HCV Coordinator at
WNMCF has a model system for tracking these patients.
There is a need for clarity regarding testing for HCV. Policy requires laboratory evidence of
impaired liver function on two occasions, two months apart before HCV testing can be done.
However, our information is that clinicians often order an HCV test on inmate request, without
waiting for repeat liver function tests. CDC recommendations are that all inmates should be
questioned regarding risk factors for HCV infection at the time of entry medical examinations,
and those with risk factors should be tested. Only 23% of the approximately 6800 NMCD
inmates have been identified as HCV infected, a figure considerably lower than prevalence
Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

38

figures generally cited for prisons. Of those 23%, or 1589 inmates, only 24 (1.5%) are receiving
treatment.
For these reasons there is a need to be certain that quality of care, rather than cost considerations,
are driving the selection process. The UNM consultant, Dr. Sanjeev Arora, should be asked to
review the policy again to make sure that all eligible candidates will be presented to him in a
timely fashion. He should also be asked to review the data, which should be collected in the
fashion modeled at WNMCF.
19.
Wexford’s detoxification protocol is inadequate. Although detoxification is more
frequently required in jails than prisons, the need does occasionally arise in prisons, and it can be
a life or death matter. The contractor should adopt the CIWA protocol (Clinical Institute
Withdrawal Assessment), which is readily available on line.
20.
There are some space and equipment needs that should be addressed. These include the
counter-therapeutic housing for elderly men at CNMCF, inadequate clinic space at the level II
facility of PNM, additional computer stations at all clinics, extending the Pyxis medication
program and equipment to all facilities, and the need for examining rooms at NMWCF that do
not have to double as offices.
21.
The grievance process should record and track the informal grievances as well as the
formal ones.
22.
Dietitian counseling should be available to all chronically ill patients who require a
special diet. This should be a component of patient education, an area that is neglected in the
care of the chronically ill.
23.

Appropriate ADA diets for diabetic patients should be ordered and available.

24.
Where adequate on-site services are not available, diabetic patients should be sent off-site
to ophthalmologists for their annual retinal examinations.
25.
At LCCF there is a need for better coordination between the institutional mental health
staff (GEO) and the contract psychiatrists, regarding scheduling, tracking and follow-up. This
may be something deserving of attention at the other facilities as well. Consideration should also
be given to routinely having the appropriate mental health staff attend the telemedicine
psychiatry encounters. Since the patient is being cared for by mental health staff as well as by the
psychiatrist, it would seem helpful to the communication process if both were present at these
telemedicine visits.
26.
Physical therapy should be available to inmates who need it at all facilities, not just
CNMCF.
27.
Monthly health services reports at NMWCF should reflect the number of patients seen by
the physician and the number seen by the physician’s assistant, rather than lumping them
together in one total figure.

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

39

28.
It is recommended that at each facility the responsibility of HCV Coordinator be assigned
to one nurse. Likewise, it is recommended that at each facility the responsibility of chronic
illness coordinator be assigned to one nurse. It is clear that spreading these responsibilities
among several people does not result in as reliable a program.

_____________________________
B. Jaye Anno, PhD, CCHP-A

____________________
Date

_____________________________
Steven S. Spencer, MD, FACP

_____________________
Date

Health Care in NMCD Facilities, Report to Legislative Finance Committee, April 2007
Steven S. Spencer, MD and B. Jaye Anno, PhD

40

DEPARTMENT RESPONSES

TABLE OF CONTENTS
NEW MEXICO CORRECTIONS DEPARTMENT (NMCD) RESPONSE TO
THE LFC’s FINDINGS AND RECOMMENDATIONS
PRIVATE AND PUBLIC PRISONS
Privatization of Prisons: County Jail Legislation
Public Prisons
Comparison New Mexico Prisons To Other States
CPI/Per Diem/Lease Purchase

Pages 1 & 2
Pages 2 & 3
Page 3
Pages 3 - 5

INMATE POPULATION GROWTH AND LONG-TERM PLANNING
Population Projections
Page 6
Long-term Planning for Bed Space
Pages 6 & 7
FOOD SERVICE

QUALITY ASSURANCE

Pages 8 & 9

Pages 10 & 11

MEDICAL

Pages 12 - 15

ADDICTIONS

Pages 16 - 21

MENTAL HEALTH

Pages 22 - 24

Response to Dr. Spenser-Anno Report by John Robertson, M.D.

APPENDIX 1

Response to Dr. Spenser-Anno Report by Dan Collins, Ph.D.

APPENDIX 2

NEW MEXICO CORRECTIONS DEPARTMENT (NMCD) RESPONSE TO
THE LFC’s FINDINGS AND RECOMMENDATIONS
NOTE: DUE TO THE SIMILAR NATURE AND REDUNDANCY OF THE
FINDINGS AND RECOMMENDATIONS IN THE LFC AUDIT REGARDING THE
PRIVATIZATION OF PRISONS, THE DEPARTMENT WILL ADDRESS THOSE
ISSUES IN AGGREGATE INSTEAD OF INDIVIDUALLY.

PRIVATE AND PUBLIC PRISONS
Privatization of Prisons: County Jail Legislation
New Mexico does have the highest rate of private prison use in the nation because of the
legislature's involvement in the decision regarding the location of correctional facilities and
housing of inmates in Cibola County, Torrance County Santa Fe County, Lea County,
Guadalupe County and Clayton.
In regards to the statement in the LFC audit: “an inefficient design make New Mexico’s
public prison facilities increasingly expensive to operate,” the report does not mention the
legislature's "politicized process" of the issue regarding the location of prisons. This
includes the decision after the riot to build small prisons in rural areas all around the state
that do not lend themselves to economies of scale.
The report makes no mention of the legislature's 14-year delay in addressing the leasepurchase problem created by the 1989 Montano decision and makes no mention of
legislative involvement with entities involved in financing the Lea County and Guadalupe
County that put an end to the project contemplated by the competitive RFP process that
preceded the "county jail" solutions. The fact is that the current operator of the prisons in
Santa Rosa and Hobbs, The GEO Group, Inc. (formerly Wackenhut), along with several
other vendors submitted competitive bids for the Guadalupe and Lea county facilities
pursuant to a competitive procurement issued by the state in 1996. The current operator
won the competition to design, build and operate the two prisons for the state with the
projects to be financed through the issuance of revenue bonds that would be repaid by the
state (with the state owning the facilities at the end of the bond repayment terms). The
financing was effectively blocked by members of the state legislature and the operator was
forced to proceed under the cited county jail legislation using its own funds to pay for the
construction of both facilities.
The state’s election to use another’s capital for the construction costs of detention space
frees up capital that the state may prefer to use for other infrastructure needs.
The Department was facing serious overcrowding during Governor Johnson’s
administration and was even housing inmates out-of-state in Arizona and Texas. The
reason that the Department had to use the "county jail" solution was because of the
Montano decision. Rather than commending the Department for the creative use of
existing law to solve the Montano problem and the lack of capital funds available at the
time, the report characterizes the Department's efforts finding a "legal loophole". This
was not a “legal loophole”; it was the law.
1

With regard to the Lea County and Guadalupe County correctional facilities, the report
suggests over and over that the state was somehow competitively disadvantaged as a result
of the contracts being negotiated through the cited county jail legislation rather than
through competitive bidding; this is absolutely incorrect.
Although this administration inherited this reliance upon privatization in the prison
system, we feel it has evolved into a good mix for the state. Personnel from both the public
and private facilities learn from each other and compete to implement best practices for the
New Mexico prison system. The department recognizes that there are different cultures in
public facilities versus private facilities and although they may be somewhat similar, they
are united but unique. Instead of looking at the use of privatization in such a negative
manner, New Mexico should be proud that we are leading the nation and that it is working
so well. This administration believes there is enough of an advantage to continue leasing
beds from private prisons in the state, particularly due to the high cost of maintaining
existing public prisons.
The State in fact pays for hundreds of buildings, not just prisons, across the state that it
will never own. In light of the fact the state is struggling to deal with old, outdated facilities
that is currently owns, in regards to private prisons, the state is not facing such a dilemma
with respect to the facilities it pays to use on a “pay-as-you-go” basis.

Public Prisons
The designs implemented over 20 years ago for the Corrections Department were
considered to be “state of the art” design for correctional facilities. It is true that the
majority of the prison buildings located statewide are in dire need of maintenance as stated
in the report. However, the state always has difficult choices to make when appropriating
the limited amount of funds to all capital outlay needs throughout the state.
It is true that the majority of the prison buildings located statewide are in dire need of
maintenance as stated in the report; it is also true that the funding received by the
Department is allocated to repairing physical plant problems as they are prioritized.
Considerable monies have been allocated over the past three years to repair problems in
the physical plant conditions at the facilities statewide.
The funding received by the Department for maintenance and repairs is allocated to
repairing physical plant problems as they are prioritized. Considerable monies have been
allocated over the past three years to repair problems in the physical plant conditions at
the facilities statewide.
Capital appropriations directed to Corrections for repair and maintenance have always
been quickly allocated by priority to help ”band-aid” the problems by which facilities are
challenged. It is the Department’s intent to allocate wisely and to provide as much
remedial work as possible with the monies allocated.
Recent building construction efforts have utilized best practice building practices in the
newly opened Mental Health Treatment Center located in Los Lunas. This facility has
given the department the capabilities of providing mental health care to inmates that would
be otherwise housed in prisons that were not set up for this specialized type of inmate. The
2

design actually allowed for less correctional officers on staff due to the direct visibility at
master control.
Public institutions are designed to house all levels of inmates. For optimum security and
control, one officer is assigned to the housing control center and one or two correctional
officers are assigned to the housing unit floor depending on the shift assigned. In contrast,
privately run institutions are designed to house Level III inmates, which are double celled,
and require less supervision.
Comparison New Mexico Prisons To Other States
The attempt to compare the cost of operations between one jurisdiction and another is
misleading. The private prison contracts in New Mexico require the operators of these
facilities to provide substantially more space and programs to inmates than is required in
the comparison states cited in the reports. There is no similar type of facility to compare
with other states due to different missions, programs, quality of life, classification, etc. The
largest component of a facility’s costs are 1) its capital costs; 2) its labor costs; 3) the level
of required inmate programs; and 4) culture and gang activity. Construction costs are
higher in New Mexico than in the comparison states (none of the comparison states require
cells as large as those required to be built in New Mexico). Labor costs are also
significantly higher in New Mexico than in Oklahoma or Texas, two comparison states used
by the LFC audit. The other jurisdictions do not require the owner/operator to pay an
eight percent gross receipts tax on every dollar of revenue received by the owner/operator.
CPI/Per Diem/Lease Purchase
The report completely ignores the fact that all pricing assumptions for private prison
contracts were carefully reviewed and considered by the Attorney General’s Office, the
General Services Department and the Department of Finance and Administration when the
contracts were initially negotiated. Very capable individuals in these state agencies spent a
great deal of time and effort going through every provision of these contracts, and in
particular, those sections dealing with compensation.
The report fails to mention that the general restriction on the annual increase in the Lea
County and Guadalupe County agreements to 80 percent of the CPI rather than 100
percent of the CPI was the Department’s method of not paying an inflationary increase on
construction costs. (Approximately twenty percent of the per diem was for construction
costs.) The operator and the state agreed to this provision when the original contracts were
negotiated. This twenty percent provision still remains in those contracts and should offset
the report's cost assessment to a great extent. The 20 percent of the original negotiated per
diem rate that was agreed to represent the owner’s return on invested capital (fixed
construction costs) has never been adjusted by an annual CPI. The LFC report indicates
the department could not provide supporting documentation for this claim. However,
rarely is there documentation of negotiations. The supporting documentation is found in
the final contract, which states that the increase is limited to 80 percent of the CPI.
Most of the difference in the cost of housing prisoners from FY01 through FY06 is simply a
matter of reasonable annual pricing adjustments consistent with the CPI and increased
operator obligations such as security upgrades and programming. State spending on
private prisons has also increased substantially due to an increase of inmate population,
which has grown 21 percent from FY01 to FY06. Costs over time are also affected by
increases in wages and the cost of necessary goods and services. The department believes
3

that the mixed use of public and private prisons in the state is working well but recognizes
that there is a savings by leasing beds.
The Department eliminated the second tier (lower) per diem rate at Lea County
Correctional Facility and Guadalupe County Correctional Facility in 2001 to pay for the
security and other upgrades required as a result of the riots/disturbances at those facilities
and recommendations from the Independent Board of Inquiry (IBI) Report.
The Legislative Finance Committee staff does not favor CPI increases, although the report
seems to suggest that for the medical contract, the inflationary increase should be limited to
the CPI, but not 2 percent in excess of CPI.
If we don’t use CPI increases, it is difficult to get a long-term contract at the Department’s
discretion. In other words, we would have to allow the contractor to terminate without
cause with perhaps 180 days written notice.
It is virtually impossible to expand Camino Nuevo Correctional Center because of its small
site. This facility will never achieve an economy of scale. The Department will not be able
to negotiate an equal per diem rate/tier, or perhaps even a lesser per diem rate/tier at
CNCC as compared to NMWCF. The Department was forced to use this facility because of
overcrowding at the NMWCF. There was also the ACLU lawsuit and the New Mexico
Population Control Commission to deal with. It will be impossible to get 10 to 50 inmates
housed at no additional cost as suggested by the LFC.
The Department has amended the NMWCF contract to temporarily (May and June, 2007)
reduce the minimum guarantee from 580 to 530. This will result in cost savings by not
requiring the Department to pay for beds it is not using. The Department is in the process
of negotiating what will happen beginning July 1, 2007.
The per diem at Clayton is higher due largely, if not entirely, to higher construction costs.
If the Department had waited to sign the Clayton agreement until the Montano
decision/Constitutional amendment issue was finalized (voted on by the voters), the costs
would now be even higher. Because of this uncertainty, DFA wanted the Department to
stay away from any express lease-purchase language. Again, fortunately, the agreement
expressly provides that the Department/state may purchase the facility and does not
prevent an amendment adding a lease-purchase arrangement. The Department may
pursue this option.
The Clayton agreement does not prohibit the Department from amending the contract to
provide for a lease-purchase agreement. In fact, the agreement expressly allows for the
Department to purchase the facility.
The Department will consider lease-purchase agreements for Clayton, as well as future
facilities, although perhaps not those located on sites currently owned by private entities
(i.e., LCCF and GCCF).
Department Action Items
The Department will meet with the private prison operators to discuss and attempt to
resolve, to the extent possible, concerns raised in this audit report.
4

NMCD will attempt to renegotiate the private prison contracts to ensure staffing levels are
maintained at a reasonable level including some mandatory posts. In addition, the
department will monitor vacancy rates at private prisons on a more regular basis and will
track, monitor and enforce the number of programs canceled and identify the reason for
any cancellations.
The Department will also require contractors to submit monthly reports indicating
coverage for the mandatory positions and we will monitor and enforce them accordingly.

5

INMATE POPULATION GROWTH AND LONG-TERM PLANNING
LFC Finding: Executive policy combined with the department’s lack of active long-term
planning to accommodate inmate growth had led to a disjointed and costly approach to acquire
needed bed space.
NMCD Response:
Population Projections
With regard to the LFC’s finding indicating the Department will require additional bed
space by 2009, based upon internal (compiled by the department) inmate population
projections, the department projects it may require additional bed space in FY2011, not as
soon as FY2009, as indicated in the LFC finding. The department disagrees with the
figures provided in this finding because the numbers were based upon projections
compiled by the department’s consultant on inmate population projections, JFA Associates
LLC., which have been unpredictably overstated this fiscal year. Historically, the
department’s population projections from JFA have been generally accurate, within 2
percent of the actual inmate population over a 12-month period. However, recent JFA’s
projections are 8 percent higher than the actual population. Therefore, the department is
not completely relying on JFA’s projections to provide accurate information other than
their rate of growth from where the department is now.
The department has internally revised the inmate population projections by applying the
same or a similar rate of growth to the projections based on where the department is now.
As a result, reaching capacity is predicted to happen in FY2011. The major reason for the
change is that the department has actually seen a decline in population rather than an
increase so that where the population projections start is even lower than the starting place
was at the beginning of FY2007. The department will be receiving updated population
projections from JFA by June 30, 2007.
Long-term Planning for Bed Space
The legislature's "politicized process" of the issue regarding the location of prisons
includes the decision after the riot to build small prisons in rural areas all around the state
that do not lend themselves to economies of scale. In the past, the legislature's involvement
played a significant role in the decision regarding the location and housing of inmates in
Cibola County, Torrance County Santa Fe County, Lea County, Guadalupe County and
Clayton. Currently, the legislature's involvement is playing a significant role in the
decision regarding the location of any expansion to the prison system. The report's
recommendations regarding statutory changes do not fully address this issue.
The Department acknowledges there has been a disjointed approach to prison planning
and commits to commissioning a study for this purpose. In the interim, the department
plans to continue to populate the Camino Nuevo Correctional Center for female offenders
and for male offenders, continue to populate Springer and Clayton. And, when the time is
appropriate and in order to achieve better economies of scale, the Department expects to
lease additional bed space at existing facilities (e.g. Guadalupe County Correctional
Facility, Lea County Correctional Facility) for male offenders.
Unless and until the Springer Correctional Center is expanded, it will never lend itself to an
economy of scale. However, part of the Legislature's concern once the Department
6

obtained the facility was to ensure that every existing employee received a Department or
other state job. Again, at the time, it only makes sense for the Department to utilize the
facility in order to reduce overcrowding and reduce the possibility of litigation by inmates,
such as re-activating the Duran consent decree (as to the surviving provisions that address
overcrowding) and potential ACLU litigation.
The Department agrees with removing restrictions on prison locations set out in statute.
Although the Department has no strong objections, there appears to be no need to repeal
the statutory authority that allows the Department to use special funds (i.e., permanent
fund land income) to acquire prisons.

7

FOOD SERVICE
LFC FINDING: IMPROVED MONITORING OF FOOD SERVICE CONTRACTS COULD
REDUCE COSTS AND INCREASE DEMONSTRATED QUALITY.
LFC Finding: The Aramark contract provisions are generally structured in the best interest of
the department.
NMCD Response:
The Safety Programs Manager will be the custodian of the monthly food service inspections
and will meet monthly with each of the private food providers to discuss issues and initiate
corrective action for ongoing or common facility issues. Information from these meetings
will then be distributed to all inspectors. (Via e-mail)
LFC Finding: The department meals call for 3,400 calories per day for an inmate, which is more
than comparable entities and makes meals more expensive.
NMCD Response:
Food is also very important to the security and safety of a prison. The calorie count of
3,400 calories per day required by the Department is a contributing factor in the cost of
meals. This calorie count is necessary to serve a southwest style meal which is nutritionally
adequate and transportable.
There are three major reasons for the difference of the cost of meals versus other entities:
1) this was the lowest price offered in a competitive bid process; 2) meal costs are part of
the per diem of private prisons; and 3) the delivery system is not as complex in a private
facility versus a public facility. Private facilities were designed differently so that there is
no additional cost for delivery of meals considering meals are prepared on-site. However,
for public facilities, the food vendor prepares food in a central kitchen and delivers to
correctional units. Employees who enter high security prisons are more costly than
average food service workers and must stand by until the meal is consumed. (labor cost)
To address economies of scale, the contract was set up so that the vendor could absorb the
cost/loss at small facilities and remote locations where not enough meals are served to pay
for the operation. (e.g. Roswell Correctional Center)
The private prison food cost on the report does not take into account the coordinating
management, and the dietician that are required for a statewide food service operation that
serves approximately 10,000 meals a day.
LFC Finding: Lack of consistent food count policies and ineffective monitoring tools may result
in overpayments.

NMCD Response:
Facility meal billings need to be looked at a little closer. The details of how the billings are
established are important. For example if a sack lunch is made and charged and the
facility uses population count for billing, it could result in a “double billing” when only one
meal is consumed. Special diets, officer meals, medical snacks, special details, and
transports, could also account for some of what appears to be excessive charges.
8

In order to keep better track of these details, Adult Prisons and the Training Academy are
in the process of developing and implementing a standard counting system and form for
meals served that can be easily audited and/or reconciled.
LFC Finding: The department does not regularly monitor or evaluate Aramark contract
performance or enforce sanctions.
NMCD Response:
Facility personnel will conduct monthly inspections and the Safety Programs
Administrator will perform an annual inspection for both public institution and the
training academy food service facilities/vendors. The inspection form will be re-developed
and broken into three parts.
1. Food safety/security
2. American Correctional Association standards
3. Contract compliance
Training of all staff assigned to the inspection team will be conducted on an annual basis or
as necessary for new inspectors. The safety programs manager will be the custodian of the
monthly food service inspections and will meet monthly with each of the private food
providers to discuss issues and initiate corrective action for ongoing or common facility
issues. Information from these meetings will then be distributed to all inspectors.

9

QUALITY ASSURANCE
LFC FINDING: THE DEPARTMENT ENSURES BASIC COMPLIANCE WITH POLICIES
BUT COULD IMPROVE PRISON OPERATIONS FURTHER BY INCREASING ITS FOCUS
ON PERFORMANCE.
LFC Finding: The department ensures basic compliance with policies but could improve prison
operations further by increasing its focus on performance.
NMCD Response: Due to the complexity of the prison operations, the Department will
move toward performance standards in conjunction with and as the American
Correctional Association moves in the direction of compliance standards. The Department
will also look to enhance our performance-based measures and sanctions for lack of
performance.
•

LFC Finding: The department does not measure or monitor performance in key aspects
of prison operations such as its inmate classification system.

NMCD Response:
The NMCD acknowledges the lack of performance-based measures in the key aspects of
the operations of our prisons. The Department is currently in the process of restructuring
a Deputy Director position that will be responsible for compliance and monitoring at both
private and public facilities. This position will coordinate with other staff (Classification
Bureau) in order to ensure compliance and improve performance measures. We will
provide monitoring and training to staff in order to accomplish this.
The Department is currently in contract negotiations with a new medical vendor with
whom we are holding accountable for maintaining low vacancy rates. The Department
agrees that there should be an automatic deduction penalty for unfilled mandatory
positions.
LFC Finding: The department has implemented an extensive quality assurance (QA) process to
ensure basic compliance with policy and the American Correctional Association (ACA)
accrediting standards.
NMCD Response: The Department is in the process of restructuring our quality assurance
office by designating a deputy director who will be in charge of compliance and monitoring
at both private and public facilities. This position will coordinate with other department
and private facility staff in order to ensure and enforce compliance, and improve
performance measures to include a focus on staffing levels at private facilities. The
oversight process will include recommended
sanctions for not meeting certain
requirements in the contracts. We will, as a Department, provide monitoring and training
in order to implement these improvements.
LFC Findings: Central office does not always use QA information to improve compliance or
monitor performance of public and private prisons. The department could increase efficiencies
by integrating contract monitoring criteria with key compliance audits of private prisons.
10

NMCD Response:
The Department recognizes the need for better lines of communication in regards to our
contract monitoring and compliance audits. We will review and update the measures along
with the restructuring process. We believe our staff has taken appropriate measures by
having key central office staff continually visit and monitor our facilities to evaluate quality
of life and conditions of confinement by having quarterly warden’s meetings, weekly phone
calls, frequent visits and peer interaction. We disagree that we do not utilize data obtained
to ensure corrective action and to validate information provided. The Department will
work in concert with the ACA standards to enhance our performance-based measures.

11

MEDICAL
LFC FINDING: THE DEPARTMENT NEEDS BETTER OVERSIGHT TO CONTAIN
MEDICAL COSTS AND ENSURE THE PROVISION OF ADEQUATE CARE.
In regards to medical costs and adequate medical care for inmates, the Department
acknowledges that there are system-wide problems with healthcare delivery. The
Department also acknowledges that the key areas of staffing vacancies, and departmental
monitoring require a new approach, including new contract requirements, internal
resource allocation and legislative funding. Departmental reorganization, the medical RFP
and subsequent contract, coupled with the tasks completed and scheduled will serve to
address and satisfactorily resolve these issues.
The Department has also made successful efforts in monitoring the Wexford medical
contract and has recovered money from them for staffing shortages and improper billings
totaling $159,517. Also, the Department just received Wexford's quarterly report for
January, February and March 2007, and will analyze their billings for staffing shortages.
LFC Finding: The quality of inmate medical care varies by facility, however the department has
failed to systematically ensure Wexford delivers adequate medical services.
NMCD Response:
NMCD acknowledges that there are system wide problems with health care delivery. The
Department also acknowledges that the key areas of staffing vacancies, and departmental
monitoring require a new approach, including new contract requirements, internal
resource allocation and legislative funding. Departmental reorganization, the medical RFP
and subsequent contract, coupled with the tasks completed and scheduled will serve to
address and satisfactorily resolve these issues.
•

LFC Finding: Wexford’s insufficient record keeping, the lack of meaningful and
consistent reports and poor communication between Wexford and the Department has
limited oversight of access to care, particularly for off-site specialty care.

NMCD Response:
NMCD acknowledges that the record keeping has been inadequate and requires
compliance with national and community standards. This will be overseen by CQI studies
coupled with increased departmental oversight. The new contract will stipulate timely
reports and impose penalties for non-compliance.
•

LFC Finding: The Department’s lack of a medical director during part of 2006 greatly
compromised its oversight responsibility for quality of care.

NMCD Response:
Effective May 2007, the NMCD has hired Stephen Vaughn, M.D. as its medical director.
He is in transition and will assume full-time duties effective June 14, 2007.
•

LFC Finding: Improved monitoring of inmate’s access to care and addressing
complaints is needed.

12

NMCD Response:
The new medical director’s responsibilities will include providing clinical oversight of the
contractor’s performance and attending the off-site referral (“collegial review”) meetings
and the Hepatitis C Treatment Review Committee (TRC) meetings. He will also be
responsible for conducting regular provider meetings, Pharmacy and Therapeutics
Committee meetings between NMCD Health Services Bureau and the medical contract
vendor. Concerning electronic medical records (EMR), the NMCD is exploring linking
with existing EMR’s in other state entities, specifically UNM (Power-chart) and/or pending
EMR chosen by the Department of Health. These explorations are preliminary in nature,
but will take a “strategic view” of the best long-term interests of the state.
•

LFC Finding: Corrections Department oversight and the quality improvement program
have failed to identify problems in a timely fashion.

NMCD Response:
The Department has proposed reorganization administratively (both for Health Services
and other contract monitoring) specifically addresses this concern. New positions and
reassigned duties, with a combined focus on problem recognition and solutions, will be an
integral part of departmental oversight. NMCD Health Services Bureau will be updating
the current auditing tools and will conduct regular site audits on delivery of health care.
•

LFC Finding: Wexford’s chronic illness program fails to meet national standards,
resulting in poor medical outcomes for inmates.

NMCD Response:
NMCD acknowledges that the Chronic Disease Management program has been inadequate
and has so informed the new medical contractor. The expectation is that this shall
substantially improve as this is the “hub” of any well-functioning medical care delivery
system.
LFC Finding: The department has not effectively monitored the cost of medical services or
enforced key contract provisions such as staffing requirements.
NMCD Response:
The Department has made successful efforts in monitoring the Wexford contract
recovering money from Wexford for staffing shortages and improper billings. The
Department has recovered $35,000 in staffing shortages for psychiatrists and $53,517 in
staffing shortages for other positions from June 2005 through December 2006. The
Department also recovered approximately $71,000 from Wexford for improper billings
(double billing) on Camino Nuevo Correctional Center inmates. Also, the Department just
received Wexford's quarterly report for January, February and March 2007, and will
analyze the bill for staffing shortages.
•

LFC Finding: The contract with Wexford provides for an automatic price increase,
regardless of performance or justification for increased medical costs.

NMCD Response:
The Legislative Finance Committee does not like CPI increases, although the report seems
to suggest that for the medical contract, the inflationary increase should be limited to the
13

CPI, but not 2 percent in excess of CPI. If we don't use it, it is difficult to get a long-term
contract at the Department's discretion. In other words, we would have to allow the
contractor to terminate without cause with perhaps 180 days written notice.
Clarifying the definition of and procedure for collecting “paybacks” for failure to meet
staffing levels will address vacancies in the medical contract. The Department will enforce
contract provisions for collecting "paybacks" by utilizing a Deputy Director made
responsible for specifically monitoring contract compliance. Also, the Department will
require Contractors to submit monthly staffing reports.
•

LFC Finding: The department does not regularly obtain information about Wexford
medical spending to ensure the adequacy of the contract amount and prevent
inappropriate cost containment that could impact inmate care.

NMCD Response:
The Department is currently negotiating a new contract (with a new vendor) that will
eliminate vacancy savings, and spells out clear penalties and shall be enforced. Final
staffing pattern is under negotiation but will increase by at least 15%.
Because of penalty clauses, the new medical contractor will have a substantial vested
interest in compliance with negotiated staffing patterns.
NMCD and new medical contractor will jointly address and assure that this is improved
with a focus on “medical outcomes.” NMCD will mandate and assure that this is up to
date and reports are rendered in a timely manner and lead to appropriately focused
Corrective Action Plans.
•

LFC Finding: The department has allowed Wexford to by-pass using local medical
providers in some areas, such as Hobbs, which results in increased security and
transportation costs for off-site care.

NMCD Response:
New Mexico has a shortage of consultants throughout the state, particularly in more
remote areas. While NMCD acknowledges that contracting with local consultants and
decreasing transports is optimal, other options are being explored, namely:
•
Increased use of telemedicine for consultant services
•
On-site clinics using UNM/community physicians on-site
•
Reduction of level of services for certain medically complex patients at
remote sites by movement into the Albuquerque area so as to increase access
and reduce transport distances.
•

LFC Finding: The department lacks adequate staff to oversee a complex and expensive
medical system that serves over 6,500 inmates across ten facilities.

NMCD Response:
NMCD acknowledges with the increasing numbers, medical complexity, and aging of the
prison population, coupled with overall greater disease burden, that reorganization and
assignment of health services monitoring as an important priority mandates immediate
14

attention. The NMCD is in the process of reorganization including reporting lines, position
reclassifications, and position creation to provide the necessary support.

15

ADDICTIONS
LFC FINDING: MORE INFORMATION IS NEEDED TO DETERMINE BOTH THE
QUALITY AND EFFECTIVENESS OF THE DEPARTMENT’S INPATIENT ADDICTIONS
SERVICES.
LFC Finding: The department allocates about 700 beds to therapeutic communities (TC) which
serve as residential substance abuse rehabilitation programs.
NMCD Response:
We disagree with the finding that we do not have sufficient dedicated housing units.
All New Mexico Therapeutic Communities (TC) do operate in dedicated housing units.
Some of these units, due to staffing and treatment space constraints include a “contracted
bed population”. Contracted beds (originally called “Drug-Free”) were part of the Duran
Substance Abuse expert’s recommendations to continue TC graduates, and individuals
waiting for treatment, in positive living environments with some continuity of care
programming. TC inmates, in our system, do interact with the general population inmates
for many activities including education, food services, recreation etc.
LFC Finding: National evaluations demonstrate that in-prison therapeutic communities can
significantly reduce recidivism based on meeting certain program standards.
NMCD Response:
We agree that in-prison Therapeutic Communities can significantly reduce recidivism
based on certain program standards.
NMCD Addictions Services does work towards the model and requirements for impacting
recidivism with Therapeutic Community programs. Our policy seeks to attract and impact
offenders within two years of release, create generally separate units within general
populations, utilize standardized program components throughout our TC system, and
make recommendations for specific targeted aftercare. We utilize assessments, interviews,
and records reviews to screen inappropriate placements and attempt to prioritize the
placement of offenders. We also utilize a plethora of approaches within the TC programs to
raise inmate’s engagement in treatment.
Our efforts are impacted by the following challenges within our overall correctional
system:
1) Lack of resources at the Reception and Diagnostic Center to conduct extensive
addictions assessment and referral to specific addictions programming.
2) Housing units and prisons, which by their design and security parameters, do not
allow true full separation of Therapeutic Community inmates and
programming from general population.
3) Population pressures which result in significant transfers of inmates prior to their
program completion. This does not allow them to leave from a TC program
directly to community aftercare.
4) Many TC residents are initially exposed to TC programming, especially many
more violent offenders at Level III prisons, and have longer time to release. This
again limits those directly transitioning to the community.
16

5) Limited community and corrections resources to provide intensive TC focused
aftercare.
LFC Finding: The department’s TC program meets many, but not all, national standards but the
lack of coordinated aftercare programs and other deficiencies may severely limit its overall
effectiveness.
NMCD Response:
We disagree with the recommendation of having a formal plan. We have a plan in place to
include aftercare programming.
All paroled inmates with substance abuse difficulties are mandated into services.
Improving the quality and tracking of these services for TC inmates is important and
requires efforts by all the groups mentioned. We have long supported dedicated aftercare
services. Besides the Ft. Stanton and Women’s Recovery Academy we also worked with a
program for women TC graduates, through Center on Alcoholism, Substance Abuse and
Addictions (CASAA) a few years back (it ended with the loss of federal funding).
•

LFC Finding: Lack of totally separate housing unit.

NMCD Response:
We disagree with the finding that we do not have sufficient dedicated housing units.
All New Mexico Therapeutic Communities (TC) do operate in dedicated housing units.
Some of these units, due to staffing and treatment space constraints include a “contracted
bed population”. Contracted beds (originally called drug-free beds) were part of the Duran
Consent Decree’s substance abuse expert’s recommendations to continue TC graduates,
and individuals waiting for treatment in positive living environments with some continuity
of care programming. TC inmates, in our system, do interact with general population
inmates for many activities including education, food services, recreation etc.
•

LFC Finding: Mixing treatment methodology.

NMCD Response:
We disagree with the finding that mixed modalities are not effective. Adding critical
information, such as infectious disease prevention, and supportive treatment elements
(AA/NA, Cognitive Behavioral), to TC programs are part of efforts to improve program
effectiveness and are supported by much of the current approaches and research efforts
nationally. (DeLeon, 2000) Inclusion of AA/NA, or other 12-step programming, is
conducted in all TC programs nationally (in prison and in communities) and most
residential treatment in the community. It adapts well to the TC model, and is essential to
the ability to provide community continuity of care, especially in a rural state like ours.
Cognitive behavioral approaches are among the best-researched and efficacious modalities
for dealing with offenders, criminal thinking, and potential impact on recidivism. These
approaches are widely used in TC programs; prison based Moral Reconation Therapy
(MRT) programs and federal substance abuse treatment programs.
We are currently working with Texas Christian University on integrating and researching
“Targeted Interventions for Corrections’ in some of our treatment programs. This is an
17

attempt to evaluate and utilize state-of-the-art approaches to specific treatment difficulties
offenders’ face.
•

LFC Finding: Lack of routinely paroling/discharging inmates near or at TC graduation.

NMCD Response:
We disagree with the finding that we do not routinely parole or discharge inmates near or
at therapeutic community (TC) graduation.
Department policy prioritizes inmates for TC inclusion with two years or less to release.
Classification transfers (mostly related to population control issues) and large TC
programs at Level III are the major challenges to releasing inmates closer to TC
completion.
TC programming has been demonstrated to have many institutional benefits. Studies
report it assists institutional adjustment, reduces violence, reduces disciplinary reports,
reduces assaults and improves attendance for correctional staff. Based on the research
literature, impacts on recidivism are primarily a function of quality and availability of
aftercare. Transfer information is available but due to lack of integration of systems is
time consuming and difficult to report. It has not been systematically evaluated.
Department efforts to reduce some of the impact of transfers include CQI efforts to
improve programs and their consistency, standardized curriculum guidelines, and
availability of TC programming at all Level II facilities and nearly all prison complexes.
•

LFC Finding: Transfers among facilities impacts inmates’ therapeutic progress and may
reduce the TC program’s overall effectiveness.

NMCD Response:
We disagree with the finding that inmate transfers between facilities reduce the overall
effectiveness of the TC program.
TC transitional aftercare programs are available at both Ft. Stanton (men) and the
Women’s Recovery Academy. Department efforts at increasing continuity of care include:
Re-entry committees and coordinators at all facilities, community transition coordinators
and transitional reporting centers. Addiction Services participates in the Governors
Substance Abuse Committee, DWI Leadership Council and Value Options meetings to
improve community aftercares services and identify needs
We are developing a pilot project for aftercare of co-occurring inmates in our TC
programs with the Behavioral Health Co-occurring State Incentive Grant (COSIG) staff.
Close efforts to utilize the AA/NA aftercare networks and faith-based mentoring through
the Santa Fe Archdiocese are in place. Lack of community resources in New Mexico is a
major factor.
•

LFC Finding: Lack of formal aftercare services.

NMCD Response:
We disagree with the recommendation of having a formal plan because we already have a
plan in place to include aftercare programming.
18

All paroled inmates with substance abuse difficulties are mandated into services.
Improving the quality and tracking of these services for TC inmates is important and
requires efforts by all the groups mentioned. We have long supported dedicated aftercare
services. Besides the Ft. Stanton and Women’s Recovery Academy we also worked with a
program for women TC graduates, through Center on Alcoholism, substance abuse and
Addictions (CASAA) a few years back (it ended with loss of federal funding).
LFC Finding: The department has not regularly evaluated the quality of services delivered and
its recent attempt at quality assurance needs improvements to make reports more useful.
NMCD Response:
We do agree with the finding that our Continuous Quality Improvement (CQI) needs
improving along with evaluating the quality of services rendered.
Department focus has been on program expansion to serve greatly expanding substance
abuse offender population. Quality evaluation has been a recent effort due to staffing
limitations. CQI currently focuses on assuring continuity of treatment, standardization of
treatment approaches, technical assistance to new programs and compliance with existing
policies. CQI can, as stated in the recommendations, expand and improve. The current
process involves direct observation and review of files and treatment processes, as well as
interviews with staff and clients. It is not based simply on data reported by program
administrators.
CQI narrative reports are a summary. Underlying data is available and may be shared
with program management, and departmental evaluators. Follow-up 30 day reports are
also planned for response to corrective actions.
Many aspects of the current CQI process was based on observation and participation in the
State of California Pacific Southwest Addiction Technology Transfer Centers approach to
“Best Practice CQI” conducted within their extensive prison TC system. It also utilizes a
standardized approach to the core elements of Therapeutic Communities based on TC
expert practice.
Lack of computerized, integrated data collection is a major obstacle to program evaluation
and quality improvement information. We will discuss this at length with our IT division.
•

LFC Finding: More information is needed to determine both the quality and
effectiveness of the department’s inpatient addictions services.

NMCD Response:
NMCD acknowledges the current lack of quality performance measures for the
Department’s inpatient addiction services and we agree that the CQI process can be
improved through data efficacy review and data reporting which would be a reasonable
enhancement to the process. The TC program performance information is available and
can be reported through improved data collection, computerization and integration of
existing systems. The effectiveness of the Department’s inpatient addictions services
remain intact due to studies that report it assists in institutional adjustment, reduces
19

violence, reduces disciplinary reports, reduces assaults and improves attendance for
correctional staff.
LFC Finding: Addictions services does not track the most basic information needed to assess
program effectiveness, such as the percentage of inmates completing the inpatient program.
NMCD Response:
We do agree with the finding that we do not track the effectiveness of the program;
however our program termination is effective.
Drug Use: Information regarding urinalysis testing is kept in program areas. It has also
been a part of the CQI process. It is not currently reported by the Addictions Bureau as
overall data, but can be easily tracked and provided. It is also reported yearly for
graduates of Residential Substance Abuse Treatment (RSAT) programs.
Program Termination: The global database, which is highly time consuming and not
integrated with other computerized systems, does have information for all program
terminations, graduates, transfers, and drug of choice. Reasons for termination are
generally violations of major program rules, significantly poor treatment progress or
security violations. More extensive breakdowns can be developed, though a reasonable
percentage of terminations are certainly expected in any treatment or correctional setting.
Percentage of TC participants completing within 12 month: This information can be
available through a time-consuming analysis of the global reports. Due to transfers, we are
aware of low percentage graduates within 12 months, especially those entering the Level III
Lea County Correctional Facility program. Better systems need to be developed to track
this type of data. We will communicate our needs with the Department’s IT division.
Average cost per TC participants: We have developed estimates for RSAT program
participants based on treatment funding vs. days of treatment provided. Overall statistics
would need to be developed with many costs variables established. Cost for treatment is
very low compared to community residential when housing/security costs are removed.
The Department will look into generating a cost benefit analysis.
Recidivism Rates for TC participants and graduates: We support these efforts to examine
“graduates” vs. “participants” especially those completing programming close to release.
Alignment with departmental systems and databases as well as integrating data is critical.
National experts tie recidivism to continuous time in treatment, release to the community
closely following program completion and especially quality aftercare. The Department is
planning to implement an offender program module to better track inmate program
participation, success and failures.
NMCD Response to LFC Recommendations Regarding Addiction Services:
Recommendation One: We agree with the recommendation of collecting and reporting TC
program performance and also tracking the inmate transfers.
Our limited data reviews indicate significant transfer and subsequent TC drop out rates.
The CQI process can be improved and data efficacy review and data reporting would be a
reasonable enhancement to the process. TC program performance information is available
20

and can be reported through improved data collection, computerization and integration of
existing systems. The Department will discuss an approach to better collection of data.
Recommendation Two: We disagree with the recommendation of freezing department
funding.
Any disruption in funding would likely result in an extensive period of time to rebuild
workforce and implement programs. New Mexico faces major substance abuse workforce
issues and trained staff to work in prisons are quite difficult to find.

21

MENTAL HEALTH
LFC FINDING: THE DEPARTMENT DOES NOT REGULARLY ASSESS THE IMPACT
OF MENTAL HEALTH SERCIES ON INMATES’ ABILITY TO FUNCTION IN A PRISON
ENVIRONMENT OR SOCIETY UPON RELEASE.
LFC Finding: The department’s extensive mental health quality assurance activities focus on
compliance with policies and are not used by management to monitor performance.
NMCD Response:
We agree that the QA audit tool needs modification and reduction. The QA audit tool was
designed and implemented during the years that NMCD was under Duran Consent Decree
reporting requirements. At the present time, the facility managers audit 96 areas in 30
patient charts. This process takes 8 to 10 hours per month. Since many of these items are
routinely at 100% compliance, this time investment is excessive, and the content areas of
the areas queried needs overhaul. The number of items in the QA audit tool will be
reduced, while simultaneously refining the quality and relevance of the content areas
audited. Content areas of the new audit tool will focus on timely access to mental health
care as well as needed assessment of the clinical effectiveness of care in improving
inmate/patient functioning. It is anticipated that the new audit tool will yield information
that is more clinically relevant to monitoring the outcome of treatment, quality of services
provided by mental health staff, and needs for improvement in service delivery.
Information derived from the new audit tool will be made accessible to wardens and other
Central Office management staff at quarterly performance meetings. The newly designed
QA audit tool should be completed no later than October 1, 2007.
LFC Finding: The department lacks meaningful performance and outcome data to ensure
mental health services.
NMCD Response:
The Mental Health Services Bureau needs to begin collecting and reporting data on four
key statistical areas relating to suicidality, crisis intervention, and return to MHTC. We
agree with this finding, but need to point out that 3 of the 4 measures are reported
monthly, and we have been doing so for many years in the Mental Health Monthly
Statistical Reports.
The LFC audit report refers frequently to the Mental Health Services Bureau Quarterly
Quality Assurance Report, but there is no mention of the Monthly Mental Health Services
Bureau Statistical Report. This monthly document provides approximately 50 to 80 pages
of monthly statistical data. It includes data from each facility on three of the four measures
recommended. The three data points reported monthly are the suicide rate; rate of suicide
attempts resulting in injuries; and the percent of inmates discharged from the Mental
Health Treatment Center (MHTC) who return within 6 months. We are not currently
reporting the fourth data point, which is the percent of inmates discharged from MHTC
who do not require crisis intervention services within 6 months. We agree that this is
valuable information to collect and analyze. We will add that reporting measure no later
than July 1, 2007.
The NMCD Mental Health Services Bureau should begin work with the Behavioral Health
Collaborative and national experts with the goal of developing a methodology for
22

demonstrating whether inmates receiving mental health services show improved
functioning in a prison environment. Seek outside training to assist the Mental Health
Services Bureau to develop continuous quality improvement (CQI) strategies and QA best
practices. We agree to conduct a study of this observation.
For a 20-year period, the Mental Health Services Bureau was accustomed to collecting and
analyzing data in compliance with the dictates of the Duran Consent Decree. In that
period, there has been considerable change in the way in which behavioral health care data
is collected and utilized by managed care organizations, and other third-party payers of
such services, including state and federal government. The MHS Bureau will immediately
begin to seek information regarding state-of-the-art methodology related to the collection
and analysis of behavioral health data. The goal of the planned modification in data
collection will be to find key measures that reliably convey the effectiveness of the services
provided. Such information will enable the Mental Health Services Bureau to determine
efficacy of treatment, and to modify practice and service delivery to improve patient
outcomes. We will begin to seek trainers to come on site to help us to develop in these
areas, and/or will attend national conferences that include needed educational trainings in
these areas.
LFC Finding: Inmates generally have sufficient access to behavioral health services, but better
monitoring is needed to ensure the effectiveness of services.
NMCD Response:
NMCD acknowledges that the Department’s Mental Health Bureau should begin to work
with the Behavioral Health Collaborative and national experts with the goal of developing
methodology for demonstrating whether inmates receiving mental health (MH) services
demonstrate improved functioning in a prison environment. The Department’s Addictions
Services also acknowledges that quality evaluation has been a recent effort due to staffing
limitations, but agrees that, as in the recommendations, can be expanded and improved.
•

LFC Finding: The department does not regularly assess the impact of mental health
services on inmates’ ability to function in a prison environment or society upon release.

NMCD Response:
NMCD acknowledges that the Department’s Mental Health Bureau should begin to work
with the Behavioral Health Collaborative and national experts with the goal of developing
methodology for demonstrating whether inmates receiving MH services demonstrate
improved functioning in a prison environment. We will initiate this collaborative process
and will seek trainers and/or national conferences to attend to meet this need.
LFC Finding: The department lacks needed bed space for acute mental health care for female
inmates.
NMCD Response:
The Department disagrees with this finding to utilize Camino Nuevo as a mental health
unit for women. The Camino facility is a Level I and II low custody facility. Interfacing it
with women who have serious mental health needs would compromise the security of the
facility. The Department would have to install security fences and lighting and have CCA
23

hire more staff to manage that particular unit. The Department agrees to look at creating
a mental health unit to accommodate more women at the New Mexico Women’s Facility in
Grants. Currently that facility has retrofitted five cells to handle the mentally ill inmates.
LFC Finding: State law requires the department to perform diagnostic evaluations of county jail
inmates, taking up valuable bed space for unknown results.
NMCD Response:
The Department agrees with this recommendation but we also understand that it is not
realistic. It would require a statutory change. In the meantime, county jails and judges
would most likely not want to keep these inmates in their jails any longer than necessary
due to the cost. It could also be difficult for some counties to find licensed professionals to
conduct these diagnostic evaluations.

24

APPENDIX 1
NMCD Responses – Solutions
To Critical Findings of the LFC Audit– From the Text of Spencer-Anno Report
By John Robertson, M.D.
Cited problem is “underlined”
NMCD response follows in text that is “Italic-Bold”.

Inadequate oversight and staffing for contract compliance
Central Office (page 2 Spencer-Anno report)

NMCD acknowledges with the increasing numbers, medical complexity and aging of the
prison population, coupled with overall greater disease burden that reorganization and
assignment of health services monitoring as an important priority mandates immediate
attention. The NMCD is in the process of reorganization including reporting lines, position
reclassifications and position creation to provide the necessary support to assure that

Nursing treatment protocols
Will review and develop as appropriate with the new medical contractor.
Chronic Care Tracking System-Hepatitis C
Re-evaluation of system needs, and meetings set up with Dr. Arora and UNM faculty to
properly coordinate care to this population of inmates.

Intake Vaccinations at CNMCF (Reception and Diagnostic Center)
Will address in the new contract.
Audit tools
Will develop at central office level and utilize existing models as appropriate.
Tele-psychiatry
Refer to Dr. Collins Response (Appendix 2)

25

MRSA reporting consistency
Will rely on DOH for direction and development of a consistent tracking and reporting
protocol

Health Services – Monthly Reports
Addressed in RFP and new medical contract
Contract review
Vacancy filling & Penalties
Physician-ACLS qualifications
Meetings & Minutes
Sick Call
HIV & HCV labs
PT & T Committee
EMR
HIV and the DOH
The above will all become part of contract monitoring and compliance assessment.

Off-site Specialty Consults
NMCD acknowledges the importance of off-site services and the need for more rigorous
oversight. This will be part of the monitoring duties of the reorganized health services.
Psychiatric Consultations
Refer to Dr. Collins response (Appendix 2)
Contract Monitoring
See prior information on Health Services reorganization and new contract requirements.

26

Equipment
NMCD acknowledges the need to assure appropriate supplies and equipment. NMCD will
assure that all equipment is certified as required.

Programs & Staffing
Refer to new staffing pattern.. Re: Physical therapist may be restricted to fewer sites and care
of inmates with these requirements in Santa Fe, CNMCF or Las Cruces.
NMCD agrees to review and update the detoxification policy and bring it up to date.
HCV program is being reorganized and the sites where treatment will be delivered will be
restricted.
Re: Psychiatry, see new requirements per RFP
Chronic care log…NMCD acknowledges that these are out of date and lacking in accuracy.
This will be a high priority for the new medical contractor and the NMCD will audit to assure
compliance with this important management tool.

27

Summary of points in the Spencer-Anno Report (Cite pages 44 – 48, Points 1-28)
“Final Conclusions and Recommendations”

1.

NMCD Medical Director
•

2.

NMCD-Wexford Contract shortfalls concerning:
-Meetings including statewide with NMCD & site and regional staff, Pharmacy and
Therapeutics Committee
-Electronic Medical record (EMR)
-Penalties for staffing vacancies
•

These issues (excepting the EMR) are all addressed in the RFP and will be specifically
spelled out in the new medical contract, effective July 1, 2007.

•

Concerning EMR, the NMCD is exploring linking with existing EMRs in other state
entities, specifically UNM (Powerchart) and/or the pending EMR chosen by the
Department of Health. These explorations are preliminary in nature, but will take a
“strategic view” of the best long-term interests of the state.

3.

Staffing Issues in current contract
•

4.

NMCD acknowledges that the existing contract staffing levels are not adequate for
present Departmental needs. This is addressed in the new RFP and is currently in
negotiation. (Attach here Staffing matrix proposal)
Vacancy rate- retention issues and penalty enforcement

•

5.

Effective July, 2007 Stephen Vaughn, Ph.D., M.D. will assume full-time duties in this
position providing Health Services the necessary leadership. (Attach updated CV for
LFC review)

See answer above, this is addressed in the RFP.

Communication issues and monitoring

Options for EMR as well as improved computer support and electronic information exchange
is currently being addressed in contract negotiations

28

•

6.

This is under review and will be an on-going project and focus for the first year of the
contract

Continuous Quality Improvement (CQI)
•

The NMCD’s proposed reorganization administratively (both for Health Services and
other contract monitoring) specifically addresses this concern. New positions and
reassigned duties with a combined focus on problem recognition and solutions will be
an
integral
part
of
departmental
oversight.
(Insert here – Reorg information plan and information)

7.

Documentation and the Intake Process
•

8.

The NMCD acknowledges that the RDC process is critical to successful delivery of
health services. Under the director of its new Medical director, Dr. Vaughn, with
assistance from Dr. Devendra Singh (who set up the highly effective and efficient RDC
process at WNMCF in the 1980’s) the department will coordinate with its new medical
vendor to improve and address the process as an early priority.
Sick call tracking & documentation

•

9.

The NMCD agrees that this requires system-wide standardization and will mandate this
as a necessary CQI activity by the medical contractor. The format will be subject to
departmental approval and will be monitored for accuracy of reports and subsequent
improvements made based upon the data.
Sick call triage (Provider levels)

•

10.

The department concurs that RN and mid-levels are the appropriate health care staff to
conduct sick call and triage patients. This is be negotiated in the new contract and will
be monitored by the NMCD to assure compliance.
Sick call schedule-Frequency

•

NMCD acknowledges the NCCHC requirements that sick call be available 7 days/week
and will include in monitoring parameters timeliness of access to a higher level
provider for inmates whose complaints can no be simply addressed by nursing
protocols.

•

Concerning expertise level for conducting sick call the NMCD agrees that a RN should
conduct these and will negotiate this into the new contract. The new staffing level will
cove this requirement.

29

11.

Sick call “No-shows”
•

12.

The department concurs that no-shows should be followed up and will work to assure
that this is the standard operating procedure under the new contract.

Chronic disease management-CQI and Oversight
•

NMCD will make this a primary focus of overall system oversight and management.
This will evolve with the new contract requirements, coupled with the reorganization of
departmental oversight.

13 & 14.
•

The NMCD will commit to these as standard operations include this in the new
contract and track compliance (rate of vaccination offering and delivery) as an
“outcome measure”.

15. & 16.
•

17.

Pneumococcal pneumonia (“Pneumovax”) vaccination
Measles, Mumps and Rubella (MMR) vaccine

Off-site referral process
Consultants, access and remote sites

Various options will be discussed with the medical contractor, other state entities
(UNM) and local physician groups to best structure a system to provide access in the
most efficient and effective manner. Telemedicine (multiple subspecialties) is being
explored as an option as are on-site specialty clinics.

HIV screening & Management – Joint Powers Agreement with the DOH
•

18.

Will rely on DOH for direction and maintenance of this important joint health care
mission. NMCD commits to audit outcomes (clinical parameters) as part of its CQI
and to seek continued funding from the legislature as needed to serve this subpopulation of inmates.
Hepatitis C Infection – Screening, treatment and management

•

With the new medical contract, effective July, 2007 the department will enter into
direct discussions with the UNM – ECHO program to assure a more effective
collaboration. It is anticipated that this may require changes in operating procedures
of the programs, new staffing assignments and changes in policy. The department is
confident that this can be satisfactorily restructured and increase access and completed
treatment. Once established, this will be a focus for CQI and internal monitoring.

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19.

Detoxification Protocol
•

20.

The NMCD will commit to review and revise this protocol to assure compliance with
national and community standards as appropriate for prisons.

Geriatric Housing Unit CNMCF – Space and equipment needs system wide
•

The NMCD agrees to address this in the new contract as well as with state entities and
the legislature so as to best provide care to this growing sub-population of the NMCD.

•

During the contract negotiations and the first months of the contract the department
will perform an equipment inventory and develop a plan for maintenance and
upgrades as required by clinical need.

21.

Grievance process
•

The NMCD will commit to review, revise and audit as appropriate the medical
grievance process. The department will work with the medical contractor and draw on
best practices for tracking and assuring that the grievance process is responsive and
creditable

22. & 23.
•

24.

Dietitian counseling/patient education
ADA diets for diabetic patients

This issue will be jointly addressed with the new medical contractor as well as the
departmental food services contractor.
Annual exams (Dilated funduscopic examination) for diabetic retinopathy

•

25.

The department concurs that annual DFE is the community standard of care for
diabetics and will incorporate this standard into policy as well as an “outcome”
measure in monitoring for contract compliance.
Coordination at LCCF between mental health and Psychiatry

•

26.

Refer to Dr. Collins response (Appendix 2)

Physical Therapy availability and access
•

The department concurs that physical therapy access and availability is an important
aspect of health care. Because of the statewide shortage of qualified therapists, the
department will undertake to study with the new contractor a systems approach to
assure that all medical necessary physical therapy is available to inmates who require
this care. Options include consolidation of inmates with special needs, local contracts
and a traveling physical therapist.
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27.

NMWCF – Monthly reports
•

28.

The department concurs that under the current contract reports have been inadequate
in both frequency and content. This will be addressed in the new contract and
appropriately enforced.
Site nursing assignments for specialty services, i.e. HCV, Chronic care

The department concurs that continuity and efficiency are best achieved by specific
assignments of responsibility. As noted in our response to item # 18, HCV is being specifically
reevaluated. Based on final determination of site missions, staffing and system needs,, the
NMCD will develop and institute the necessary changes to assure programmatic success.

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APPENDIX 2
NMCD Responses to Dr. Anno-Spencer’s Findings
By Dan Collins, Ph.D.

NMCD Psychiatry Services response to LFC audit report

Finding- Technical problems with telemedicine equipment at LCCF. We agree there have been
technical problems in the past.
Recommendation- We feel most of these technical problems have been fixed. LCCF and most
other telepsychiatry facilities received major equipment upgrades recently including new polcom
units and 42-inch monitors. There have been occasional technical problems periodically with
telepsychiatry, which is a new treatment modality that relies heavily on technology such as the
polycom unit, the monitor and the telecommunication lines all working well. All technical
problems are reported to the Department’s Health Service Bureau Clinical Director of Psychiatry
using the NMCD telepsychiatry reporting form. If a telepsychiatry clinic does not occur due to
technical problems, a lockdown of the facility or any other reasons the telepsychiatry clinic is
rescheduled for a later date, usually the next week or sooner.
NMCD has a telepsychiatry monitoring process in place. All NMCD documents regarding the
telepsychiatry clinic monitoring process are kept at the Central Office Health Services Bureau
with the NMCD Clinical Director of Psychiatry. It is unclear if the LFC medical auditors knew
about this telepsychiatry clinic monitoring process since the documents are kept by NMCD in a
binder at Central Office, not at each facility.
Finding- At LCCF, the “Geo Mental Health Director has only recently begun to track the
frequency of cancellations of the psychiatric clinics. This should be tracked regularly so the
problem can be addressed by Wexford.” “Obviously, a better system needs to be in place to
ensure that psychiatric patients are followed on a timely basis.” We disagree that this is the
process for scheduling and monitoring Psychiatry Chronic Care Clinics at LCCF.
Recommendation-There is a system in place at LCCF that was not mentioned in the LFC
auditors report. Psychiatry Chronic Care Clinic scheduling is not the responsibility of the Geo
Mental Health Manager. The Geo staff does not make the actual psychiatry appointments. The
GEO mental health log referred to in the LFC audit report is used for mental health caseloads,
not scheduling psychiatry chronic clinic appointments.
Wexford is responsible for all Psychiatry Chronic Care Clinic scheduling and coordination of
the on-site psychiatry chronic care clinics and telepsychiatry clinics. It is unclear if the LFC
medical auditors actually reviewed the Wexford Psychiatry Chronic
Care Clinic scheduling logs and the Wexford Psychiatry Chronic Clinic Master Log. Reviewing
the Geo Mental Health records or logs will not provide up to date information whether the
inmates were re-scheduled or not in the psychiatry chronic care clinic.
Wexford medical staff, not Geo Mental Health staff, fills out the cancellation data. The
frequency of cancellations is tracked using the Tele-Psychiatry Consultation reporting form
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which includes data on number of patients refusing appointments, any no shows for
appointments and rescheduled patients due to any cause.

Finding- At LCCF, telepsychiatrists “came on site once last year, not twice as required by
contract.” We agree there have been telepsychiatrist facility visit problems in the past.
Recommendation-Wexford agreed verbally to have the telepsychiatrists do site visits at each
facility they cover every six months and hold onsite psychiatry clinics. This has been a
compliance issue with Wexford. The times when this occurred the Department had to repeatedly
request Wexford to have the telepsychiatrists come to New Mexico to make facility site visits
and hold on-site psychiatry clinics. The new RFP and contract requires all in-state
telepsychiatrists and every three-month on-site psychiatry clinic visits.

Finding- At CNMCF, “psychiatric care is provided by Wexford via telemedicine. We disagree
at CNMCF psychiatric care is provided by Wexford via telemedicine.
Recommendation- The statement that at CNMCF-“psychiatric care is provided by Wexford via
telemedicine” is not accurate. At CNMCF all psychiatrists are on-site psychiatrists. There are no
telepsychiatry clinics at the CNMCF facility.

Finding-Better Coordination of Care between Mental Health staff and Psychiatry staff. We
agree partially, such as LCCF and GCCF facilities where the Department has found a need
to improve the coordination of psychiatric and mental health care.
Recommendation- Mental Health staff is to attend telepsychiatry encounters with the
telepsychiatrists, each session, usually before and after the telepsychiatry session. These
meetings are to occur frequently and regularly for case staffing, treatment planning and
discussion of difficult cases. Facilities, which have on-site psychiatrists, the psychiatrists and the
mental health staff, hold regular meetings in person to coordinate patient care. At the Mental
Health Treatment Center, Mental Health and Psychiatry staff meets weekly on Tuesdays from
9am to 12 pm for treatment team meetings to coordinate care of all patients.
LCCF has had compliance issues with Geo Mental Health staff attending telepsychiatry
encounters with the telepsychiatrists. Problems of this nature have been noted before during
psychiatry audits. Recently the Geo Mental Health staff and Wexford medical staff at LCCF and
GCCF have been reminded of the need for better coordination of care. The change in the next
contract to mandatory site visits every three months by the telepsychiatrists and in-state
telepsychiatrists will improve greatly the coordination or care between Geo Mental Health staff
and psychiatrists.
Quality improvement issues with Psychiatry and Mental Health are coordinated and reviewed
jointly at the NMCD Central Office level by the NMCD Clinical Director of Psychiatry and the
NMCD Mental Health Bureau Chief. The NMCD Clinical Director of Psychiatry and the NMCD
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Mental Health Bureau Chief are graduates of the same post-doctoral training program and have
an excellent working relationship.

Finding –“The department has not effectively monitored the cost of medical services or enforced
key contract provisions such as staffing requirements”. We disagree regarding the psychiatry
contract monitoring portion.
Recommendations- Psychiatry services provided by Wexford have been closely monitored.
Psychiatry physician and psychiatry nurse FTE reports with vacancies and specific type of staff
positions vacant or filled, not simply aggregate FTEs, have been received monthly from Wexford
for every month since the beginning of the contract.(Since July 1, 2004) These forms are placed
in a binder at Central Office.
Meetings with the Clinical Director of psychiatry and Wexford Corporate and Regional Office
staff are documented in writing using the NMCD Psychiatry Contract Monitoring form which
documents compliance or problems with the following key areas: FTE or staffing issues
(Psychiatrists/Nurses), Clinical issues, Corrective action plans, Pharmacy/psychotropic
medications, Therapeutic restraint/seclusion, Telepsychiatry, CQI, and the Alternative Placement
Area. These forms are placed in a binder at Central Office.
The Department fined Wexford $35,000 for Psychiatrist staffing vacancies early in the contract
when this occurred which significantly improved the overall psychiatry staffing for the
remainder of the contract.

Finding-“The department lacks adequate staff to oversee a complex and expensive medical
system that serves over 6,500 inmates across ten facilities.” We agree regarding the NMCD
Clinical Director of Psychiatry position.
Recommendation- The position for the NMCD Clinical Director of Psychiatry will increase
from 0.75 FTE to full time starting June 4, 2007.

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