STATE OF VERMONT CONTRACT APPROVAL REQUEST -Fonn

AA-14 (Rev 2/94)

Contract #
Change #

'7 ~ ac /

1. GENERAL INFORiVIATION
AgencylDepartment: AHS/Departrnent of Corrections
Contractor: Prison Health Services, Inc.
Address: 105 Westpark Drive, Suite 200, Brentwood, TN 37027
Fed. ID or Social Security #: 23-2108853
VT Dept of Taxes Business Acct #: F-26619 (ifrequired by law)
End Date: January 31, 2008
Start pate: February I, 2005
Summary of contract or amendment: Inmate Health Services

n. FINANCIAL INFORMATION
$ 29,534,793.00
Maximum amt. payable under contract:
If amendment, amount of change:
Rate:
%
Source of Funds: Gen. Fund 100% Fed. Source
Finance Codes (Appropriation and AID #): 3480004010
:J. /0- 0
Vendor Number:
/

If renewal prior contract #
Prior Maximum Amount:
Prior Rate:
Other
%
Source

is

III. SUITABILITY OF PERSONAL SERVICES CONTRACT
[2] Yes D No Does this contract include any supplies, materials, parts or commodities?
[2] Yes D No Does this contractor meet all three parts of the "ABC" definition of independent contractor?
(See Bulletin 3.5). Ifnot, please indicate why this work is being arranged through a contract.
DYes [2] No Is agency liable for income tax withholding or F.r.C.A.?
DYes [2] No Should contractor be paid on the state payroll?
IV. PUBLIC COMPETITION
The agency has taken reasonable steps to control the price of the contract and to allow qualified businesses to compete for the work
authorized by this contraCi.The agency has done this through:
[2] Formal bid or RFP
D Simplified bid process
D Other process (explain)
EBB #: C0I37 Renewal #:
V. CONFLICT OF INTEREST
I certifY that no person able to control or inflnence award of this contract had a pecuniary interest in its award or perfdnnance, either
"'-personally or through a member of his or her household, family, Or business.
D Yes ~ No Is there an l1appearance" ofa conflict of interest so that a reasonable person may conclude that this contractor was
selected for improper reasons? (If yes, explain)
f. ...

VI. PAYMENT VERIFICATION
DYes [2] No I want the Financial Operations Division to verify that payments under this contract agree with its payment
provisions. If I check "NO", I understand that my agency mustinsure that payments made are in accordance with the provisions of the
contract.
VII. PRIOR APPROVALS REQUIRED OR REQUESTED
[2] Yes D No This contract must be approved by the Attorney General under 3 VSA § 31 I (a)(10) (over $10,000)
(L'J Yes D No Already performed by in-house A.A.G.?)
[2] Yes D No 1 request the Attorney General to review this contract as to form.
([2] Yes D No Already performed by in-house A.A.G.?)
[2] Yes D No This contract must be approved by the Secretary ofAdministration.

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Contract # 7891
Contractor: Prison Health Services, Inc.
Agency:
Department of Corrections

Change # 1

This contract is amended only as follows:
The following is added at the end of section II. (W), Pharmaceuticals:
"The State will cause a financial plan and design performance audit to be
conducted relative to pharmaceuticals. Said audit will be conducted on or about June
30,2005. If in the determination of the State, savings can be achieved relative to
pharmaceuticals, the State will take the pharmaceutical portion of this contract to bid
and reserves the right commencing January 1, 2006 to obtain pharmaceutical products
and services from a different provider. In the event that the State opts to obtain
pharmaceuticals from a different provider, all other terms of this contract shall remain in
effect."

We the undersigned agree to be bound by this amendment.
Contractor

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STATE OF VERMONT
STANDARD CONTRACT FOR PERSONAL SERVICES

REV DATE 8/10/95
Contract #
Change #

'1 '6 'i f

I, Parties This is a contract for personal services between the State of Vermont, Department of Corrections (hereafter
called "State"), and Prison Health Services, Inc, , with principal place of business in Brentwood, Tennessee, (hereafter
called "Contractor"), Contractor's form of business organization is a corporation, Contractor is required by law to have a
Business Account Number from the Vermont Department of Taxes, Account Number is F-26619,
2, Subject Matter The subject matter of this contract is personal services generally on the subject of health care to
inmates, Detailed services to be provided by the Contractor are described in Attachment A.
3, Maximum Amount In consideration of the services to be performed by Contractor, the State agrees to pay Contractor
in accordance with the payment provisions specified in Attachment B a sum not to exceed $29,534,793,00,
4, Contract Term The period of Contractor's performance shall begin on 2/1/05 and end on 1131/08,
5, Prior Approvals If approval by the Attorney General's Office or the Secretary of Administration is required, (under
current law, bulletins, and interpretations), neither this contract nor any amendment to it is binding until it has been
approved by either or both such persons,
l'<-C\I Yes I 0 I Approval by the Attorney General's Office required,
r ~I 0 IN<:> I Approval by the Secretary of Administration required,
6, Amendment No changes, modifications, or amendments in the terms and conditions of this contract shall be effective
unless reduced to writing, numbered and signed by the duly authorized representative of the State and Contractor.
7, Cancellation This contract may be cancelled by either party by giving written notice at least 90 days in advance,
8, Attachmel1ts This contract consists of 112 pages including the following attachments which are incorporated herein:
Attachment A - Specifications of Work to be Performed
Attachment B - Payment Provisions
Attachment C - "Customary State Provisions", Revised 12/01/03
Attachment D - Modifications of Maximum Insurance Requirements
Attachment E - Business Associate Agreement (Revised 12/01/03)
Attachment F - Final Adopted Rule for Access to Information
Attachment G - PHS Implementation Plan
Attachment H - Staffing Matrix
Attachment I - Stipulation and Agreement- Vermont State Employees Association, dated 07/31/1996
Attachment J - Settlement Agreement - Goldsmith, et aI. v, Dean, et aI., dated 04/11/1996
Attachment K - Staffing Coverage Standards
Atttachment L - Independence, Liability, Hold Harmless Clause
WE THE UNDERSIGNED PARTIES AGREE TO BE BOUND BY THIS CONTRACT,
by the ST TE OF VERMONT
by the CO. ;rRACTOR
Date:
Date:.
~OS-:

Signature'~~~~::i~~~t:.z:.'::t-----Name: Steven M, Gold, C
Agency: AHS/Correctio
Name: Prison Health Services, Inc,
Address: 105 Westpark Drive, Suite 200
Brentwood, TN 37027
Fed, ID/SS#: 23-2108853
Title:

APPROVED AS TO FORM:
Attorney G/reral:
0 1
Date:
I~
I

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I

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Table of Contents
Attachment A - Specifications of Work to be Performed

I.

Introduction

.

5

II.

Health Care Services

.

6

Intake Screening
.
B. Inmate Orientation - Access to Health Care Services
.
Health Assessment.
.
C.
D.
Informed Consent. .. ,
.
E.
Inmate Workers
.
Sick Call
.
F.
G.
Health Improvement and Disease Prevention
.
H. First Aid Kits
.
Emergency Services
.
1.
Hospitalization and Payments to Health Care Providers
.
J.
K.
Infirmary Services
.
L.
Services for Incapacitated Persons
:
.
M. Special N..;eds - Chronic and Convalescent..
.
.
N. Communiciition on Special Needs
-0. Special Needs Treatment Plans
.
Suicide and Self-Injury Prevention Program
P.
.
Q. Hospice Care
.
R. Diagnosis, Consultation and Treatment.
.
Obsteh'ic and Gynecology Services
S.
.
T. Specialty Outpatient Services
.
.
U. Ancillary Services
V. Optical Services....................................................................•.....
W. Pharmaceuticals
.
X.
Medication Administration
.
Y.
Dental Services
,
.
Materials, Supplies and Equipment
Z.
.
AA. Inventory ControL
.
AB. Contaminated Waste
.
AC. Hepatitis Treatment
.
A.

III.

Personnel Services

A.
B.
C.
D.
E.

,
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.

7
8
9
9

10
11
11
11
12
13
14
14
16
16
17
17
18
18
18
19
20

21
22
23
24
24
24
24

25

.

Overview
Forensic Activities.............................
Program Manager
Regional Manager/Director
Medical Director

6

25
26
26
27
27

III.

Personnel Services (cont'd)

F.
G.
H.
1.
J.
K.

IV.

Ancillary Services

A.
B.
C.

V.

Job Descriptions...............................
Recruitment Practices
Licensure/ Certification
State Oversight..........................................
Performance Review
Staff Training and Retention..............................................

:

.

33

Correction Staff Education...................................................... 33
Staff Vaccinations
33
Coordination with the Department of Health.............................. 34

Administrative Services

A.
B.
C.
D.
E.
F.
G.
H.
1.
J.
K.
1.
M.
N.
O.
P.
Q.

28
28
29
29
29
30

..

Policies and Procedures..
..
Contract Implementation and Initiation Orientation................
Consultation. . .. .. .
..
.. .. ..... . .
.
Medical Records...................................................................
Treatment Protocols
Continuous Quality Improvement Program
Interface with DOCs Mental Health Services Provider
Disaster Management.
"
.. ... ... .
.
... . .
Management Information System.. ..
.. ...
Purchasing Procedures. . ..
.. ...
..
.....
.
Insurance
,.. .... .
Accreditation Plan
" ..... ... . .. .
.. ... .. .
Other Operational and Financial Data Reporting
Claims Processing.. ... .. ... .. . ... .. . ... ... . .... .... . .. . .. . .. . .. .. .. .. .. ... ... ..
Inmate Transfers Between DOC and Out-of-State Facilities.......
Mortality Reviews
Performance Guarantees.........................................................

35

35
35
36
36
38
38
43
44
44
45
45
45
46
48
48
49
49

Attachment B - Payment Provisions.....................................................

53

Attachment C - "Customary State Provisions" (Revised 01 Dec03)................

56

Attachment D - Modifications of Maximum Insurance Requirements........

60

Attachment E - Business Associate Agreement, (Revised 01Dec03)..............

61

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Attachment F - Final Adopted Rule for Access to Information

,....

66

Attachment G - PHS Implementation Plan

72

Attachment H - Staffing Matrices..

74

Attachment I - Stipulation and Agreement

,.. ...

... ...... ...

84

Attachment J - Settlement Agreement

86

Attachment K - Staffing Coverage Standards.....

105

Attachment L -Independence, Liability, Hold Harmless Clause.....

106

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ATTACHMENT A
CONTRACT FOR SERVICES
SPECIFICATIONS OF WORK TO BE PERFORMED

I.

Introduction

It is the purpose of this contract to facilitate and enable the delivery of health care services to the Vermont
Department of Corrections' (hereinafter DOC) inmates in Vermont. The Contractor shall:

•

meet the health care needs of inmates in accordance with applicable state and federal laws;

•

deliver all medical services in compliance with current standards set forth by the National Commission on
Correctional Health Care (hereinafter NCCHC). At such time as these standards are updated, it is
understood that the Contractor shall make necessary adjustments and modifications to ensure that
Vermont correctional facilities remain in compliance and retain NCCHC accreditation;

•

provide the services as set out in this contract in compliance with the applicable terms of the Settlement
Agreement in Goldsmith, et al versus Dean, et ai, dated April 11, 1996 (Attachment J);

•

provide a networksufficient in size, location, and scope to meet all clinical requirements outlined in
Chapter Two - Health Care Services. The clinical members of this network must also be credentialed
consistent with NCCHC standards;

•

participate in applicable state sponsored quality improvement projects as directed by the DOC (e.g.,
Vermont Program for Quality in Health Care, Diabetes Collaborative);

•

incorporate local community providers in its system of care; and

•

coordinate activities with the Vermont DOC Health Services Director or designee. In the event of a dispute
between the Contractor and the State on a clinically-related matter, the DOC Health Services Director will
have final decision making authority.

C

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II.

Health Care Services

A. INTAKE SCREENING

Contractor shall conduct a receiving screening on all new commitments (including transfers) immediately
upon the inmate's arrival at the DOC facility and before the inmate enters the general population of the
facility. This screening shall be conducted by a qualified medical professional and shall include, at a
minimum:

'i.

1) Inquiry into, and documentation of, current and past illnesses, health conditions, and special (including
dietary) requirements:
• any past history of serious infectious or disease including HIV/ AIDS and Hepatitis C;
• recent symptoms of communicable disease (e.g., chronic cough, hemoptysis, lethargy, weakness,
weight loss, loss of appetite, fever, night sweats) suggestive of such illness;
• past or current mental illness, including hospitalizations;
• past history of trauma and/ or sexual assault/ abuse;
• eligibility for Community Rehabilitation and Treatment (CRT) programs;
• history of, or current suicidal ideation;
• dental problems;
• allergies;
• medications taken (including last dose) and special health (including dietary) requirements;
• for females: date of last menstrual period, date of last pap smear, date of last mammogram, current
and past pregn~cy, and other gynecological problems;
• routine medical treatment;
• health insurance coverage;
• use of alcohol and other drugs (including last use), and any history of associated withdrawal
symptoms, detoxification needs and stabilization services for a substance abuse disorder; and
•
other health problems designated by the responsible physician.
2) Observation of the following:
• appearance (e.g., sweating, tremors, anxious, disheveled);
• behavior, (e.g., disorderly, appropriate, insensible);
• mental status (e.g., state of consciousness, suicidal ideation, alert, responsive, lethargic), using forms
developed by the State;
• ease of movement;
• breathing (e.g., persistent cough, hyperventilation); and
• skin (e.g., trauma markings, bruises, lesions, jaundice, rashes, scars, tattoos, infestations, and needle
marks or other indications of drug abuse).
3) Administration of a screening test for tuberculosis, as soon as practical after admission.
4) Documentation of the findings, date and time the receiving screening is complete.
5) Signature and title of the person completing the screening.
6) Inmate authorization for treatment.
7) Voluntary testing for HIV/ AIDS and Hepatitis C.
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All inmates with questionable health conditions will be medically cleared within twelve (12) hours of intake,
and before being sent to the general population. Inmates with non-emergent conditions will be referred to the
general population with appropriate follow-up referrals established. Inmates requiring immediate
intervention will be referred to the. appropriate health care staff for evaluation and treatment and will be seen
within two (2) hours of intake. Any referral of the inmate for special housing will be implemented in four (4)
hours. Any referral for emergency health services will be "stat." Referrals to additional medical specialists
will be as appropriate, and timelines will be imposed with regard to the severity of medical need as
determined by the referring physician. All inmates who are currently taking prescribed medication upon
intake will be medically evaluated and, if medically indicated, those medications will be made available to the
inmate in accordance with established protocols (see Section W - Pharmaceuticals for DOC protocols).
Contractor staff will be notified of all inmates requiring special housing or having activity restrictions.
Dispositions of inmates must be clearly noted on the screening form.
The receiving screening findings will be recorded on a standardized form (to be agreed upon by the parties)
that captures essential baseline health information. The intake form will be included in the inmate's health
care record. The form will be in compliance with all State and national standards.

B. INMATE ORIENTATION - ACCESS TO HEALTH CARE SERVICES
At the time of initial intake, each inmate will be provided with a written health care services orientation and
information on how to access health care services while in the facility. The orientation will include:
1)
2)
3)
4)
5)
~:..6)
7)
8)
9)
10)

Sick call processllnd procedures;
How to access emergency and routine medical, mental and dental health services;
Medication administration times and procedures;
Information on chronic care clinics;
Information on accessing mental health services;
Information on accessing dental services;
Information on accessing optometry services;
Hours of facility health center;
Information on health services in segregation; and
Issue and grievance procedures.
a.

Incarcerated Inmates with Special Needs

The Contractor shall comply with the Department's ADA policy to ensure proper accommodation for all
inmates with physical and/ or developmental disabilities.
Inmates with special needs (e.g. non-English speaking, developmentally disabled, illiterate, blind, mentally ill,
or deaf) will receive assistance, as required, to help them communicate with health care personnel and to
understand how to access health services. Contractor personnel will be trained to adequately explain an
inmate's rights to health care services. In addition, signs addressing access to health services will be posted in
the intake area and in all inmate housing areas.

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b.

Incarcerated Females

In addition to the services available to all inmates, the Contractorshall also provide female inmates written
information on how to access (a) gynecological and prenatal care, (b) breast examinations and mammograms
for age-appropriate or symptomatic inmates, and (c) routine pap tests.

C. HEALTH ASSESSMENT

Inmates housed in a Vermont DOC facility for longer than forty-eight (48) hours will receive a complete health
assessment within five (5) days of the inmate's arrival to the facility. If possible, the Contractor shall attempt
to communicate and coordinate with community providers who treated the inmate prior to incarceration. The
health assessment will be completed by a licensed nurse practitioner, physician's assistant or physician.
The initial health assessment will include:
1) A review of the receiving or transfer screening results.
2) The collection of additional health data to complete the medical, dental, mental health and immunization
histories. 1
3) A recording of vital signs (i.e., height, weight, pulse, blood pressure and temperature).
4) A complete physical examination as indicated by the inmate's gender, age and risk factors including
breast, rectal, testicular exams, HIV screening and an assessment for traumatic brain injury.
5) Pelvic, pap and breast examinations for women.
6) Laboratory and/or. diagnostic tests to detect communicable diseases including venereal diseases and
tuberculosis. The Medical Director may approve additional diagnostic procedures and testing such as a
urinalysis, when clinically indicated.
7) Inununization history and the provision of immunizations as clinically indicated.
8) The inmation of therapy and the ordering of other tests and examinations, as clinically appropriate.
~'.9) A written referral for substance abuse disorder as clinically indicated.
10) A release signed by the inmate to obtain information from the inmate's community provider (if the
provider is known) will be obtained within five (5) working days.
The form used to document the findings of the health assessment shall be in compliance with all NCCHC
standards. The form will be reviewed and approved by the Contractor's Medical Director and DOCs Health
Services Director or his/her designee. In addition, a written authorization for health evaluation and treatment
will be obtained from the inmate and witnessed by health care personnel, if a consent has not been obtained
prior to this time. This health assessment form will become part of the inmate's permanent health care record.
When the results of the health assessment indicate that the inmate requires further evaluation or h'eatment, the
inmate will be referred to the appropriate physician. The specific time for the follow-up care will be as
follows:
•
•
•

Routine Health Issues - within seven (7) days of the health assessment (or as required by the inmate's
treatment plan);
Urgent Health Issues - within twenty-four (24) hours of the health assessment (or less if required by the
severity of the case); and
Emergent Health Issues - immediate.

The mental health portion of the health assessment shall be developed in collaboration with the DOC Mental
Health Provider and the DOC s Health Services Director and health care professional staff.

1

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For re-admitted inmates who have received a health assessment within the previous ninety (90) calendar days,
the most recent intake screening, the prior health assessment and laboratory results shall be reviewed. The
physician will determine if a complete health assessment is necessary. The extent of the health assessment will
be determined by the Contractor's Medical Director.
Physical examinations shall be conducted annually. Women inmates shall be provided: (a) gynecological and
prenatal care, including consultation; (b) breast examinations and mammograms for age-appropriate or
symptomatic inmates; and (c) routine pap tests.
When an inmate is placed in segregation, the health record will be reviewed within twenty-four (24) hours by
a qualified health care professional to determine whether existing medical, dental or mental health needs
contraindicate placement in segregation or require accommodation. The health record review will be
documented in compliance with NCCHC standards. lt is essential that inmates in segregation or close custody
be cleared for placement and actively monitored daily during their period of segregation.
The Superintendent or his/her designee will be informed of any functional aspect of an inmate's physical or
mental status that may affect security, housing or work assignments or potential for violent, self-injurious or
suicidal behavior, consistent with NCCHC standards and DOC policy. The disposition of inmates not
medically suited for confinement will be discussed with the Superintendent or his/her designee. Inmates
segregated from the general population for disciplinary reasons and those who have been moved by the use of
force will be evaluated by the health care staff "stat" but at least within one (1) hour. The evaluation will be
documented in the inmate's health care record.

D. INFORMED CONSENT
The Contractor shall ensure that a patient's informed consent is obtained prior to all examinations, treatments
,.,
,. and procedures in accordance with applicable State laws and regulations including informed consent of next
"of kin, guardian or legal custodian when required. Any inmate may refuse health evaluations and treatment.
An inmate's refusal of treatment must be documented by a waiver signed by the inmate and must be part of
the inmate's medical record.
The Contractor must document its policies and procedures for obtaining informed consent and an inmate's
right to refuse treatment. The Contractor must also submit its consent forms to DOC for approval upon
execution of the Contract.

E. INMATE WORKERS
Contractor shall examine and provide medical clearance for all inmate workers, including work release
inmates. The medical clearance process will be initiated within twenty-four (24) hours of receiving the list of
inmates to be cleared. However, the need for laboratory testing may increase the time required to provide
medical clearance.
The inmate worker clearance will be documented on a standardized form and include:
1) A review of the inmate's health care record.
2) Questions regarding the inmate's past medical history, including communicable disease, cardiac problems,
pulmonary problems, allergies and back problems.
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3) Questions regarding current signs and symptoms of illness.
4) A physical examination and vital signs.
5) Documentation that the inmate has no conditions that preclude work based on criteria provided by the
Vermont Department of Health.
Inmate workers will not be allowed to provide health services or work in the health services area, except for
cleaning purposes. Inmates working in the health services area must be supervised at all times.

F. SICK CALL
All inmates will have a daily opportunity to request health care. Contractor will implement a sick call system
that provides inmates with unimpeded access to health care services. Nursing personnel will collect, triage
and respond to all inmate requests daily. Contractor will utilize the established sick call boxes. For inmates
who do not have access to the sick call boxes, alternative arrangements will be made for filing sick call
requests. The requests will be triaged and the inmates will be scheduled for health care services as medically
indicated. The frequency of sick call will be consistent with NCCHC standards and the facility schedules
shown in Attachment H.
Contractor shall follow nursing protocols, developed and implemented with the approval of the State, to
facilitate the delivery of sick call services by nursing personnel. Health staff will be trained to effectively triage
the inmate's condition and implement established protocols. Health services will be provided in a manner that
complies with state and federal privacy mandates within the scope of each facility's physical plant. If the
inmate's condition requires services beyond the ability of the nurse and/ or the established nursing protocols,
the inmate will be referred to the appropriate health provider for evaluation and treatment within twenty-four
(24) hours.
, ..' Contractor shall utilize a three-part sick call request form that allows the inmate's request, triage and
>-disposition information, and the health care encounter to be documented all on one form. The form is printed
on no carbon required (NCR) paper to provide additional copies. One copy is kept by the inmate at the time
the request is submitted. The second copy may be used for a variety of purposes. For example, if the inmate's
request does not require a health care encounter, a written response will be documented on the form and a
copy will be returned to the inmate. The original becomes a part of the inmate's permanent record.
Sick call services, in compliance with NCCHC standards, will be provided at sufficient levels to allow the
health care staff to provide same-day response to urgent inmate requests for health care services. Nursing sick
call will be conducted daily. Physician sick call will be conducted according to a set schedule agreed upon by
the contractor and the DOC. If the inmate's custody status precludes attendance at sick call, contract staff will
consult with facility security staff to facilitate access to health care services within time frames established for
inmates in the general population.
Timeliness of the response to sick call requests can be an important indicator of quality of care. Failure by
Contractor to respond to sick call requests consistent with DOC requirements will result in penalties (see
Chapter Five, Section Q - Performance Guarantees). Contractor may be charged $50 per each sick call request
outstanding for more than forty-eight (48) hours from Monday to Friday. Contractor shall make a good faith
effort to meet the forty-eight (48) hour standard from Saturday to Sunday, but consistent with the NCCHC
standards for sick call response times, Contractor will be held to a maximum of seventy-two (72) hours from
Saturday to Sunday before a penalty will be taken.
The Conti'actor will monitor sick call responses as part of their continuous quality improvement (CQl) process.
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G. HEALTH IMPROVEMENT AND DISEASE PREVENTION
Inmates benefit from individual instruction in self-care and in ways to maintain their optimal health, Health
staff are expected to provide health education during all inmate encounters, Contractor's CQI process will
monitor the delivery and documentation of inmate education,including the topics reviewed, and reference
materials provided, As specific populations are identified, educational programs will be established to
address health needs in culturally appropriate and gender responsive group settings,
The Contractor shall coordinate all health improvement and disease prevention activities with the DOC and
the Vermont Department of Health. The health improvement and disease prevention program shall include
smoking cessation, diabetes management including dietary needs, effects of drug and alcohol use, stress
management, sexually transmitted diseases, HN/ AIDS and Hepatitis, Instructional methods shall include
classes, audiotapes, videotapes, brochures, or pamphlets, The DOC Health Services Director and the Vermont
Department of Health will review and approve all educational materials, As emerging issues are identified,
new prevention topics and activities shall be added,
Contractor must be willing to coordinate inmate education programs with educators from the community (i,e"
Public Health Nurses), The Contractor shall act as a consultant for facility staff in the development of health
education/ promotion groups or classes, HIV risk reduction activities shall be coordinated with other State
agents and contractors, as authorized by the DOC and the Vermont Department of Health,
The Contractor shall include a detailed description of its health improvement and disease prevention program
in its CQI program d,escription,

H, FIRST AID KITS
.", Contractor will provide and maintain First Aid Kits for Contractor staff and inmates in custody. The First Aid
'"'
'l<its
must be secured with a plastic tear away lock. Each time the lock is broken, utilizing staff will initiate a
supply request to health care services, Nursing staff will check and replenish the contents of each kit on a
monthly basis and when requested, The monthly kit checks will be documented as required by NCCHC
standards, The location and contents of the first aid kits will be approved by the Contractor's Medical
Director, Program Manager and the correctional facility superintendents,

1.

EMERGENCY SERVICES

Contractor is required to provide an immediate response to inmates in an emergency situation. Contractor will
have twenty-four (24) hour physician telephone on-call coverage and specific written policies and procedures
to address emergency response and the emergent transfer of inmates. The Contractor also must develop a
coordinated protocol with the DOC Mental Health Provider to respond to mental health care emergencies,
Contractor shall sub-contract or maintain written agreement(s) with one or more local hospitals to provide
emergency services to inmates on a twenty-four (24) hour basis and inpatient hospitalization for all inmates in
custody (subject to conditions described in Section J below), Additionally, arrangements will be made for
Advanced Cardiac transportation and Basic Life Support transportation with local EMS and ambulance
services, Contractor shall be responsible for the emergency transport of inmates,

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Contractor shall ensure that an inmate's medical chart accurately reflects and documents services provided by
outside health care providers, as well as any emergency services provided by the Contractor.
The Contractor shall provide and document emergency medical care necessary to stabilize any injured DOC
employee, conti'act employee, volunteer or visitor who is injured or becomes ill while onsite at a DOC facility.
Any required follow-up care will be the responsibility of the person receiving the emergency care.
a. Emergency Care for Work Release Inmates
In the event that a work release inmate requires urgent/ emergent care, Contractor shall provide care at the
most appropriate facility (community or DOC) based on the inmate's health condition.
For inmates injured while on work release, whose injuries are covered under workers' compensation
insurance, Conti'actor shall be responsible for coordinating follow-up care and case management services with
the employer's workers' compensation insurer until either the inmate's treating physicianhas released
him/her to return to work or until the inmate is discharged from the DOC, whichever occurs first. Contractor
mayor may not provide care for the work-related injury at a DOC facility, depending upon Contractor's
arrangements with the State's workers' compensation insurer.
Contractor retains responsibility for delivering all medically appropriate care, regardless of inmate's access to
third party coverage. Contractor will work with the DOC to develop a specific policy and procedure to ensure
that work release inmates receive appropriate urgent/ emergent care, and to ensure case management and
follow-up care provision and coordination.

J.

HOSPITALIZATION AND PAYMENTS TO HEALTH CARE PROVIDERS

.. Contractor shall establish written agreements with local hospitals to provide services when an inmate's
~-<::ondition requires inpatient hospitalization beyond the scope of the facility to manage. Contractor Utilization
Review personnel will monitor the condition of inmates in local hospital(s) daily.
Contractor shall identify the need, schedule, and coordinate any inpatient hospitalization and related services
for State correctional facility inmates. Contractor shall also coordinate with the DOC Mental Health Provider
any hospitalization of inmates requiring mental health care services. 2 Inmates may be subsequently
transferred to a State correctional facility infirmary or other appropriate setting when medically appropriate
and practicable. Contractor shall ensure that an inmate's medical chart accurately reflects and documents
services provided by outside health care providers.
Under no circumstances shall Contractor limit or delay access to inpatient hospitalization for inmates
identified as needing this level of care. If the State believes that the Contractor is not transferring inmates
needing inpatient hospitalization in timely fashion, the DOC Health Services Director and Contractor Medical
Director shall review and resolve any dispute. Failure to reach resolution may be grounds for termination of
the contract.

If a mental health provider admits a patient to a hospital or other health care facility for psychiatric treatment,
s/he must inform the Contractor immediately.

2

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a. Provider Payments
The Contractor must have in place contracts or written agreements with hospitals for both inpatient and
outpatient services and must negotiate payment rates with these facilities that are adequate to ensure the
provision of services to the incarcerated population. The Contractor will be responsible for payment of all
inpatient hospital claims for inmates. The contractor will be responsible for all costs not covered by Medicaid,
Vermont Health Access Plan (VHAP) or other payors. Some costs may be offset for inmates who are eligible
for VHAp3 or workers' compensation during a period of hospitalization.
Contractor shall make good faith efforts to adjudicate (reimburse, deny or request additional information) all
clean hospital (and other community-based providers) claims within thirty (30) days of the Contractor's receipt
of the claims. Failure to promptly reconcile and pay clean claims may result in penalties (see Chapter Five,
Section Q - Performance Guarantees) or may be grounds for contract termination. All hospital/ community
provider claims thirty (30) days or more in arrears shall be reported to the DOC as a part of the Contract.
or's monthly quality improvement reporting
K. INFIRMARY SERVICES

Contractor shall staff and utilize the infirmary beds available at several of the Vermont DOC facilities for nonacute admissions of inmates who may require a higher level of medical attention. Inmates requiring
respiratory isolation will be housed in a designated negative air pressure room.
The scope of services' provided in the infirmary will be organized so that inmates have appropriate
classification, housing and treatment. NCCHC defines an infirmary as "an area within the confinement facility
accommodating two or more inmates for a period of twenty-four (24) hours or more, expressly set up and
operated for the purpose of providing skilled nursing for persons who are not in need of hospitalization."
;.."r

.

:--The infirmaries may be used for convalescent, medical observation and skilled nursing care. The requirements
of national standards vary depending upon the housing classification, the degree of services provided and the
defined scope of service. The infirmary beds will be classified and the scope of services will be defined
according to policies and procedures covering areas including, but not limited to:
1) Twenty-four (24) hours a day direct nursing observation will include daily, or more frequent (if medically
indicated) recording of vital signs and nurses' notes, based on the inmate's condition. Inmates will always
be able to gain a health care professionaY s attention, either through visual or auditory signals.
2) Admission to, and discharges from the infirmary will be controlled by the Contractor's Medical Director. ,
3) A physician will be available by telephone twenty-four (24) hours per day, seven (7) days per week, three
hundred and sixtycfive (365) days per year.

4) All nursing services will be under the direction of a Nurse Manager, who will be on-site forty (40) hours
per week. Staffing levels will be appropriate for the number of inmates, the severity of their illnesses and
the level of care required for each, but no less than the staffing reflected in Attachment H.

The State of Vermont Agency of Human Services determines eligibility for VHAP in accordance with the
provisions of its State Plan for Medical Assistance. All eligibility determinations, including denials, are
binding on the Contractor.

3

- 13 -

5) A separate and complete infirmary medical record will be initiated upon admission and incorporated into
the inmate's health care record upon discharge. The record will include:
•
•
•
•

admitting orders that include the admitting diagnosis, medication, diet, activity restrictions, any
required diagnostic tests, and the frequency of vital sign follow-up;
a complete documentation of the care and treatment given;
the medication administration record; and
a discharge plan and discharge notes.

6) Services will be provided according to an established manual of infirmary nursing policies and procedures.
The manual will be consistent with the Vermont's Nurse Practice Act and licensing requirements.
7) The health care staff, in conjunction with Facility Superintendent, will be responsible for ensuring that the
infirmary area is clean and safe for the provision of health care services.

L. SERVICES FOR INCAPACITATED PERSONS

Only after medical clearance by designated community providers has been obtained, including all required
signatures, shall the Contractor provide a medical screening and assistance to incapacitated persons brought to
a correctional facility. The Contractor shall provide an intake screening and observation services to these
persons in accordance the policies and procedures agreed to and approved by the State.

M. SPECIAL NEEDS ~. CHRONIC AND CONYALESCENT
a.

General

In providing health care services to the State's incarcerated population, Contractor recognizes that there may
::':·.be incarcerated individuals who require chronic and/ or convalescent treatment, including inmates 55 years
and older. It is the State's expectation that the Contractor will provide these services in a manner that
incorporates principles of case and disease management for complex cases (see section below), and promotes
maximum progress and healing. "Chronic" is defined as health care services rendered to an inmate over a
long period of time for ongoing medical conditions including, but not limited to, diabetes mellitus,
hypertension, asthma and epilepsy. "Convalescent" is defined as medical services rendered to an inmate
patient to assist in recovery from an acute illness or injury.
Health care programs provided by Contractor shall require that inmates requiring chronic or convalescent care
receive timely follow-up, evaluation, treatment and education about the preventive activities available.
Inmates with chronic conditions will be evaluated every three (3) months, in chronic-care clinics, or more
frequently if clinically indicated.
Contractor personnel will collaborate with DOCs Health Services Director to develop individual chronic
treatment plans and disease protocols, which will be individualized to address an inmate's specific needs. The
treatment plans will outline the inmate's course of care and will define and dictate the nursing staff
responsible for day-to-day health care service delivery and inmate education.
Under no circumstances shall Contractor limit or delay access to chronic/convalescent treatment for inmates
identified as needing this level of care. If the State believes that the Contractor is not providing
chronic/ convalescent treatment in timely fashion, the State Health Services Director and Contractor Medical
- 14 -

Director shall review and resolve any dispute. Failure to reach resolution may be grounds for termination of
the conh·act.
b. Case Management of Complex Cases
Active case management is essential for ensuring that inmates with complex medical, mental health and/ or
social needs receive necessary services in an effective and coordinated manner. The Contractor will have a
system in place within the facilities for providing case management to complex medical cases. The decision
about who is to receive active case management will be made jointly by the Contractor and the DOC's
Executive Health Services Committee. The Committee will meet to review cases and make determinations
about adding or removing inmates from case management. Examples of cases that will be candidates for
active case management include, but not be limited to, inmates with HIV/ AIDS, Hepatitis C, fragile elderly
inmates, insulin-dependent inmates, and inmates with high-risk pregnancies.
Case managers will have education and training in the delivery and monitoring of health services, and be
responsible for all of the following:
1) Performing a needs assessment and developing individual treahnent plans (under the supervision of a
physician, as appropriate) that address, as applicable, diet, exercise,
medication, type and frequency of medical follow-up and adjushnent of treahnent modality.
2) Monitoring inpatient hospitalizations and conducting discharge planning from both the hospital and/ or
facility .
3) Coordinating pOBhdischarge follow-up services, including within non-acute settings such as rehabilitation
facilities and nursing homes.
Case managers will also be responsible for ascertaining whether an inmate has health insurance from any
source, including individual or employer-sponsored coverage (self, spouse and/ or family), automobile
.;';'_coverage (if admitted with vehicle-related injuries), workers' compensation (if injured while on work release),
military coverage (TRICARE), Veterans Administration, Medicaid, or Medicare coverage. If so, the case
manager will document the name of the insurer, coverage type, group/policy number, expiration date, and
other information necessary for filing a claim. The Contractor will then facilitate collection on the State's
behalf.
In those cases where third party reimbursement is available, inmates shall be encouraged, but not required, to
sign insurance claim forms.
For inmates injured while on work release, whose injuries are covered under workers' compensation
insurance, Contractor shall be responsible for coordinating follow-up care and case management services with
the employer's workers' compensation insurer until either the inmate's treating physician has released
him/her to return to work or until the inmate is discharged from the DOC, whichever occurs first. Contractor
mayor may not provide care for the work-related injury at a DOC facility, depending upon Contractor's
arrangements with the State's workers' compensation insurer. Contractor retains responsibility for delivering
all medically appropriate care, regardless of inmate's access to third party coverage.
If an inmate does not have any other insurance covering health care services, the Contractor will assist the
inmate in completing a VHAP (Medicaid) application to be signed and placed in the inmate's health record.

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To the extent possible, with or without third party reimbursement, the Contractor shall attempt to coordinate
with community providers who h·eated the inmate prior to incarceration.

N. COMMUNICATION ON SPECIAL NEEDS
To effectively meet the needs of inmates with special medical and mental health needs, it is absolutely essential
that positive, open and continue communication exists between the Contractor's staff and the DOC s staff.
Regular channels of communication must be established and maintained between Contractor's health care staff
and the Facility Superintendent and facility staff to ensure a continuum of care for sick inmates, while
maintaining the security and the health and safety of other inmates and facility staff.
Contractor's health care staff and DOC facility administration will communicate no less than weekly about
inmates who are:
•
•
•
•
•
•
•
•
•
•
•
•

chronically ill;
on dialysis;
adolescents in adult facilities;
infected with serious communicable diseases;
physically disabled;
diagnosed with traumatic brain injury;
pregnant;
frail or elderly;
terminally ill;
mentally ill or suicidal;
developmentally disabled; or
seriously ill with significant health conditions.

,>..-,'

'·This communication is vital in order facilitate accurate classification of inmates, which is important for
protecting the health and safety of the inmate, other inmates and staff.

O. SPECIAL NEEDS TREATMENT PLANS
The Contractor will develop and maintain treatment plans for inmates with special needs as listed in Section
M. These treatment plans will include, at a minimum:
1) the frequency of follow-up for medical evaluation and adjustment of treatment modality;
2) the type and frequency of diagnostic testing and therapeutic regimens; and
3) instructions about diet, exercise, adaptation to the correctional environment, and medications, when
appropriate.
Special needs will be listed on the master problem list in each inmate's medical record. The Contractor will
maintain an ongoing list of special needs inmates, and will make this information continuously available to
facility administration and the DOC Executive Health Committee.

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P. SUICIDE AND SELF-INJURY PREVENTION PROGRAM
Multiple corrections' disciplines (security, physical health, and mental health care) play an important role in
suicide and self-injury prevention. These roles must be coordinated in terms of philosophy and in operations.
The Contractor has a significant role to play and shall have policies and procedures that are aligned with, and
subordinate to, DOC policy, directives and procedures.
Contractor must coordinate with the State and its agents in the delivery of a comprehensive suicide and selfinjury prevention program promulgated by the DOC and designed to identify, respond to, monitor, and h'eat
suicidal and self-injurious inmates. The suicide and self-injury prevention program must include written
policies and procedures that address key components of the program.
At a minimum, key components include those defined by NCCHC, and are as follows:

•
•
•
•
•
•
•
•
•

training
identification
referral
evaluation
housing
monitoring
communication
intervention
notification
reporting
review
critical incident debriefing

Contractor must perform quality monitoring activities at least quarterly in order to assess adherence to the
.;".program.
".~'

Q. HOSPICE CARE
The Contractor shall coordinate with the Deparhnent and community organizations in the coordination and
delivery of hospice services to inmates. The hospice care unit will be located at the Southern State Correctional
Facility in Springfield, Vermont. The DOC Health Services Director will assist in the coordination of the
Contractor's care of hospice patients with other organizational units in the DOC, and with community
organizations regarding aspects of care for these inmates, including the use of medical furlough.
The Contractor's staff working in the hospice program should be qualified health care professionals with
training in basic hospice theory and techniques. The Contractor shall ensure that enrollment in the program is
an inmate's informed choice, and that an independent evaluation by a physician not directly involved in the
inmate's care is c,?mpleted prior to enrollment. The DOC Health Services Director will approve all transfers to
the hospice unit.

. 17·

R. DIAGNOSIS, CONSULTATION AND TREATMENT
Contr·actor's health delivery systems will be designed to allow the physician time to concentrate on those
inmates with significant health conditions. Contractor shall provide follow-up and treatment for health
problems identified by screening or diagnostic tests. When appropriate, nursing protocols will be
implemented. If an inmate's health condition cannot be appropriately addressed with a nursing protocol, the
inmate will be referred to the Medical Director by the attending nursing staff.
Contractor's Medical Director and DOC s Health Services Director will be available for second opinions and to
review consultation requests. Contr·actor shallcoordinate all necessary hospitalization, monitoring, diagnostic
testing, prescriptions and specialty consultations to appropriately address an inmate's health condition.

S. OBSTETRIC AND GYNECOLOGY SERVICES
The Contractor shall provide annual gynecological consultations and perform pap and breast examinations on
all female inmates, unless contra-indicated by a qualified medical professional. Annual mammograms shall be
performed on all female inmates over forty (40) years of age, unless contra-indicated by a qualified medical
professional.
'
Pregnant inmates require close supervision and perinatal care by the Contractor. The Contractor shall also
develop a plan to meet the special needs of pregnant inmates.
Currently, the Dale Correctional Facility and Southeast State Correctional Facility house all female inmates.
The Contractor's staffing at these facilities should include an OBjGYN trained health care practitioner who is
qualified to meet the needs of the inmates in these facilities.

SPECIALTY OUTPATIENT SERVICES
Contractor shall develop a network of qualified medical specialists to provide inmates with necessary access to
health services. Contr·actor shall enter into written agreements with said specialists who practice in the local
areas, and provide the DOC Health Services Director with a current list of all specialists to be utilized.
For HIV-positive inmates, treatment shall be coordinated through the Infectious Diseases Unit at Fletcher
Allen Health Care. The Contractor shall make every reasonable effort to comply with the clinical management
protocols for inmates who are HIV-positive, as directed by the Infectious Diseases Unit, including providing
protease inhibitor drug treatment, as clinically indicated. Disputes over specifics of inmate care shall be
resolved by the DOCs Health Services Director. The Contractor shall contact (if the inmate gives consent) a
local AIDS Services Organization to facilitate transitional care for inmates with HIV j AIDS who are being
released from the correctional system.
Contractor shall arrange for qualified medical specialists to visit the facilities so that inmates may be
maintained within the security of the Contractor facility. If necessary, an outside referral will be made for
services that cannot be provided at the facility. To the degree possible, diagnostic testing will be performed
on-site. A referral process will be initiated to provide specialists with all pertinent information necessary for
timely diagnosis and treatment The medical specialist will receive diagnostic testing results, substantive
patient history and clinical findings, in the form of a written referral.
- 18 -

Contractor shall be responsible for scheduling, authorizing and coordinating all specialty services. Contractor
will coordinate the movement of ininates to off-site appoinhnents with the Vermont DOC facility
superintendents and/ or their designees. All inmates returning from outside hospital stays or clinic visits will
be seen by a medical professional immediately upon return, and a progress note regarding the review will be
documented in the inmate's health record. Conh'actor shall ensure that an inmate's medical chart accurately
reflects and documents services provided by the outside health care provider(s).
Under no circumstances shall Contractor limit or delay access to specialty services for inmates identified as
requiring this care. If the DOC believes that the Contractor is not providing specialty services in a timely
fashion, DOCs Health Services Director and the Contractor's Medical Director shall review and resolve any
dispute. Failure to reach resolution may be grounds for termination of the conh'act or the impositions of
financial penalties reflected in Chapter 5, Section Q - Performance Guarantees.

U. ANCILLARY SERVICES
Contractor shall establish and maintain a comprehensive range of ancillary support services. Contractor shall
identify the need, coordinate and pay for all supporting diagnostic testing and examinations, both inside and
outside the State correctional facilities. All subcontractors will be required to meet state and local licensure
requirements and provide proof of Professional Liability insurance.
a. Laboratory Services
Contractor shall contract with a laboratory to provide diagnostic testing. Laboratory testing will include
routine, special chemistry and toxicology analysis. The laboratory will meet all requirements of the State of
Vermont for HlV specimen handling, testing and reporting.
,-.- All services provided shall meet standards set forth by the American College of Pathology. Services will
""mclude timely pickup and delivery and accurate reporting within a reasonable time frame with provisions for
stat lab testing as necessary.
Requests are to be initiated by a phone call to the laboratory. A log will be maintained to document the type
and number of specimens sent, and those returned. A lost specimen will be reported immediately, so that the
lab may be repeated. A physician will review, date and initial laboratory results. Once reviewed, the results
will be filed in the inmate's health care record. When discrepancies exist, the physician will re-evaluate the
inmate and re-order the laboratory tests, as appropriate. Crisis levels will be reported to the physician
immediately. Each month the laboratory will provide Contractor with an itemized statement of the service
rendered the prior month.
The laboratory service will meet all State of Vermont requirements for medical pathology.
Contractor shall establish a policy and procedure manual for all laboratory testing performed on-site.
Laboratory testing performed on-site or off-site will be in compliance with the Clinical Laboratory
Improvement Amendments of 1988.
b. Radiology Services
A radiology technician will be on-site to provide radiology service on a scheduled basis. Inmates will be
referred off-site for procedures beyond the scope of service provided on-site. A Board-Certified radiologist
will read the studies in a timely manner. The radiology report will be documented and maintained in the
- 19 -

inmate's health care record. The Contractor's Medical Director will review, initial and date all radiology
reports. A verbal notification of all positive findings will be furnished to the Medical Director or his/her
designee within three (3) working days; this verbal notification is to be followed up by a written notice of
findings within ten (10) working days.
c. Diet Therapy
Special diets will be available to inmates when medically indicated and prescribed by a physician. Contractor
personnel will complete a Therapeutic Diet Order form and forward it to dietary services. The order will
include the type of diet and the duration for which the diet is to be provided. The inmate's orientation to the
therapeutic diet will be documented in the health care record. In accordance with NCCHC standards,
Contractor shall coordinate reviews of all diets at least every six (6) months with a registered dietitian.
d. EKG Services
Contractor shall provide EKG services and necessary EKG equipment. The EKG contract will provide for
immediate reading and reporting of results of EKG. Nursing staff will receive in-service training related to
EKG services.
e. Medical Prosthetics
Contractor shall establish contracts with local prosthetic companies to provide prosthetic devices to inmates as
medically indicated. The contract will require the company representative to make preliminary measurements
and fittings for prosthetics on-site. Prosthetics will be chosen according to community standards, but also
must conform to security requirements of the DOC.

," V. OPTICAL SERVICES
~

Contractor shall respond to the self-reported need or medical referral for optical intervention and schedule,
coordinate and pay for the dispensing, evaluation, and fitting services of an optometrist. Inmates requesting
health care services for visual problems will be evaluated using the Snellen eye chart by nursing staff. If a
visual deficiency beyond 20/40 is identified, the inmate will be referred to Contractor's optical service
provider.
Contractor shall provide one (1) set of eyeglasses to inmates if prescribed and deemed necessary by the
optometrist. Inmates requiring treatment and services beyond the scope of services offered on-site will be
transported to specialists in the community. Inmates shall be eligible to receive follow-up eye exams every
two (2) years.
Contact lenses and tinted lenses will be provided by the Contractor only in response to a verified medical need
and not for cosmetic purposes.
The Contractor shall not provide replacement eyeglasses more frequently than every two (2) years unless
medically indicated. If the eyeglasses are lost or damaged due to the inmate's negligence, he/ she will be
responsible for the cost of replacement. The Contractor will only provide a replacement when the need occurs
through no fault of the irunate.

- 20-

w.

PHARMACEUTICALS

Contractor shall provide a total pharmaceutical system in compliance with NCCHC standards that is sufficient
to meet the needs of the DOC inmates. Contractor shall also be responsible for the acquisition, storage and
administration of pharmaceuticals. Policies, procedures and practices addressing pharmaceuticals will be in
compliance with all applicable state and federal regulations regarding dispensing, administering, and
procuring pharmaceuticals.
A cost-effective agreement with a pharmaceutical vendor will be established. If an agreement is established
with a national vendor, a contract or other arrangement will also be established with local pharmacies to
provide time-sensitive access to all medications. Under the capitated model, expenses for psychotropic
medications will be billed back to the State with a pass through of any discount negotiated and received by the
Contractor from the pharmacy vendor.
The pharmaceutical system will have the following components and comply with NCCHC standards:
1) Medication ordered by a qualified provider (physician, psychiatrist, nurse-practitioner, dentist) will be
appropriately labeled and will be in unit-dose packaging.
2) A pharmaceutical inventory will be established to facilitate the initiation of pharmaceutical therapy upon
the physician's order. An inventory control system will b" implemented to ensure the availability of
necessary and commonly prescribed medications, and to protect against the loss of pharmaceuticals. All
pharmaceuticals will be prepared, maintained and stored under secure conditions.
3) An adequate andproper supply of antidotes and emergency medications will be available.
4) Addictive, abusable, and/ or psychotropic medication will be administered in crushed or liquid form,
when the need for such is so determined by DOC requirement, the prescriber and/ or nurse manager.
S) Monthly Quality Improvement (QI) monitoring of medication administration records and physician
prescribing reports. Quarterly reviews will be completed by a consulting pharmacist using a Pharmacy &
Therapeutics (P&T) format
6) Compliance with security and training requirements of the facility and DOC.
7) An automatic stop order system for certain categories of drugs (i.e. antibiotics, controlled substances, pain
medications).
8) The use of generic brand medications whenever possible, unless otherwise specified by the prescribing
provider.
9) A physician will evaluate each inmate prior to re-ordering medications.'
Contractor will maintain a formulary listing the available medications. The formulary must be submitted to
the DOCs Health Services Director or designee for review and approval before being implemented.
Compliance with the formulary will be encouraged. However, if the DOC Health Services Director or
Contractor Medical Director determines that the most effective treatment is a non- formulary medication, this
medication will be made available to the inmate. Non-formulary medications will be obtained by completing
a non-formulary request form.
The Contractor will be responsible for monitoring the use and availability of all pharmaceuticals. Specifically,
the Contractor must ensure timely availability of all pharmaceuticals that are part of an inmate's treatment
- 21 -

plan, and shall report all occurrences of drug unavailability as a part of its monthly CQI reporting. The
Contractor is subject to performance penalty of $1,000 for every occurrence of not providing pharmaceutical
drugs in within two (2) hours of the date and time medication is scheduled to be dispensed for an inmate's
ongoing treatment plan (e.g., insulin for insulin-dependent diabetics, protease inhibitors for HIV/ AIDS
patients, etc.). For newly ordered prescriptions, Contractor may also be penalized if prescriptions are not
delivered within forty-eight (48) hours of order receipt, from Monday through Friday and seventy-two (72)
hours from Saturday through Sunday, or within one (1) hour of receipt of a "stat" provider's order. (See
Chapter Five, Section Q - Performance Guarantees.)
Contractor shall perform quality improvement monitoring and tracking of physicians' prescriptive data to
provide for safe, cost effective and efficient pharmacy services.
a. Medications for Work Release Inmates
Contractor shall ensure that work release inmates have access to all necessary medications. Contractor shall
make every effort to provide medications at a DOC facility, but may provide medications on a keep on person
basis in accord with DOC policy and procedures.
Contractor will work with the DOC to develop a specific policy and procedure for dispensing medications to
work release inmates.
b. Medications Prescribed by Mental Health Providers
All mental health medications will be billed as incurred to the state on a monthly basis, with a pass-through of
any discounts negotiated and received by the Contractor. Budgeted amounts for mental health medications
included in this contract (and reflected in the Price Provisions, Attachment B) are $240,000 in Year 1, $270,000
in Year 2 and $300,000 in Year 3. Contractor will not bear any risk for these medications.
c.

Methadone and Buprenorphine at DOC Facilities

Contractor shall provide physicians certified to dispense Buprenorphine as part of its narcotic withdrawal
program at DOC facilities.
Contractor shall work with the DOC and its Mental Health Provider to ensure that methadone facilitation is
available to inmates, as determined by and in agreement with DOC policy. While Contractor shall not be
responsible for the provision of methadone, it is responsible for identifying potential candidates,
communicating the need for treatment and coordinating methadone treatment with the Mental Health
Provider for DOC inmates.

X. MEDICATION ADMINISTRATION
The Contractor shall maintain a medication administration system that meets the DOC s needs. Once a
medication order has been written, nursing staff will transcribe the order onto the medication administration
record and inform the pharmacy of the medication order. If the prescribed medication is available in the stock
supply, the medication therapy will be initiated on the next medication round. Contractor shall ensure that
medications ordered "stat" will be obtained and administered within one (1) hour.

- 22-

Medication will be administered to iruuates by nurses or other authorized personnel three (3) times daily or as
ordered. Medications will be either administered at a health services unit or delivered to each irunate housing
area, as jointly determined by the Contractor and DOC. It is understood that security considerations,
architecture and facility custody level impact the method for distributing medications. Facility
superintendents will be actively involved in the discussions and determination of most appropriate method at
each site. Contractor may use the State's self-carry protocol. Inmates will have access to over-the-counter
medications during scheduled medication rounds.
The administration of each medication will be documented on a medication administration record.
Documentation on the medication administration record will clearly indicate those instances when an irunate
refuses a medication or is not available to receive a medication. Medication administration times will be
adjusted to meet the needs of irunates who participate in work details or classes. lf an inmate refuses a specific
medication three (3) times, the irunate will be counseled and requested to sign a refusal form.
Contractor's medication administration program shall contain internal controls to provide for re-order prior to
the expiration of the initial order, if required. The system must ensure the provision of continuous
pharmaceutical therapy.

Y. DENTAL SERVICES
The Contractor shall provide access to dental services in accordance with NCCHC standards and State law.
The Contractor's sub-contractor arrangements with dental providers shall be in conformance with Vermont
Statute 26 V.5.A. Ch;{pter 13 § 722.
Contractor shall provide on-site dental services which include preventive and restorative care. The Contractor
will provide a schedule, by facility, to the State with the hours that dentists will be on-site actually seeing
, ..- patients (Le., exclusive of time used for set-up and dismantlement of equipment and for administrative
'''"'activities). The hours across all facilities must equal at least eighty (80) hours.
The initial dental appraisal and instruction in oral hygienewill be conducted at the time of the initial health
assessment by h'ained registered nurses and within five (5) days of admission. The Contractor's provision of a
dental screening for all referred inmates shall be conducted by a licensed dentist within timeframes established
in the Settlement Agreement (Attachment J) and NCCHC standards, whichever may be shorter. If the
Contractor is unable to provide on-site assessment, screening and/ or treatment within these timeframes,
inmates shall receive services through local community dentists, with costs for said services to be borne by the
Contractor.
In the case of are-admitted irunate who has received a dental examination within the past six (6) months, the
Contractor shall assure that a licensed dentist determines the need for an additional dental evaluation. Nurses
who provide dental screening and oral hygiene instruction will receive in-service training from a licensed
dentist under contract to, or employed by the Contractor.
Inmates may request dental services by submitting a sick call request. The nurses will triage the requests and
submit them to a licensed dentist. Inmates will be seen based on the list of dental priorities. Inmates who
require h'eatment beyond the capabilities of the Contractor's licensed dentist will be referred to a dental
specialist in the community. Dental prostheses will be provided as determined by the dentist in accordance
with the accepted community standard of care.
- 23 -

Z. MATERIALS, SUPPLIES AND EQUIPMENT
Contractor ohall provide all medical, dental and office supplies necessary for the provision of health services.
Contractor shall provide all necessary supplies and equipment to carry out the terms of the contract. Supplies
will include, but not be limited to, forms, books, health care record folders'and forms, pharmaceuticals,
prosthetics, dental hand instruments, needles and sharps, special medical items, diagnostic devices, containers
and medical waste receptacles, inmate education materials, personnel protective equipment, and program
manuals.
In addition, all necessary office equipment and supplies will beprovided by the Contractor. Contractor shall
make arrangements to have the necessary equipment and supplies delivered to the DOC's facilities within one
(1) month of cOntract implementation (date service delivery begins). The DOC owns certain pieces of
equipment (i.e., dental chairs) which may be used by the contractor.
Contractor shall ensure that the health care services area is safe, secure (e.g., doors and cabinets locked), and
sanitary for the provision of medical and dental care. In addition, all diagnostic equipment and patient items
will be maintained in working order, as defined by the manufacturer. The DOC will receive copies of all
inspection reports for such equipment.

AA. INVENTORY CONTROL
All syringes, needles and sharps will be stored and maintained within security regulations and guidelines set
forth by NCCHC st';;;dards, VOSHA requirements, and CDC guidelines. The use of each needle, syringe or
scalpel will be documented on a perpetual inventory record. All syringes, needles, sharps and dental
.instruments will be accounted for daily.
,'- At each change of shift, two nurses will count all narcotics and any other items subject to abuse. If the count is
'"
--correct,
each nurse will sign the contTol record. The DOC Health Services Director, Contractor Medical
Director, Director of Nursing and the State Correctional
Facility Administration will be notified of all unaccounted for discrepancies as soon as practicable, not to
exceed twenty-four (24) hours.

AB. CONTAMINATED WASTE
Contractor will be responsible for the disposal of all contaminated waste. This may include waste generated
outside the facility when an inmate is on temporary authorized absence. Contractor will contract with a
company authorized to provide for the disposal of all biohazardous and contaminated waste. Biohazardous
and contaminated waste will be maintained in accordance with the guidelines established by OSHA.

AC. HEPATITIS TREATMENT
It is recognized by the PaTties that Hepatitis in general, and Hepatitis C specifically, represent an increasingly
serious public health threat to inmates nationally and in Vermont. It is agreed that the Contractor will provide

appropriate treatment, consistent with NCCHC and/ or CDC guidelines, according to protocols developed by
the Contractor and the State. The State Health Services Director shall make final decisions concerning inmate
eligibility for treatment under these protocols.
- 24 -

III.

PERSONNEL SERVICES

A. OVERVIEW
Contractor will identify the need for, schedule, coordinate and pay for all non-emergency and emergency
medical and dental care rendered to inmates incarcerated in state correctional facilities, consistent with
NCCHC standards, Vermont State statutes and applicable Federal statutes, and the determination of the
Vermont DOC Health Services Director.
Contractor shall hire qualified health care staff as defined in this contract to provide a comprehensive health
care program to meet the medical and dental needs of the inmates housed within the DOC, according to
coverage schedules for each of the facilities per the Staffing Matrix (Attachment H). It shall be the Contractor's
final responsibility to fill all posts in accordance with the staffing standards and coverage schedules per the
Staffing Matrix, exclusive of posts filled by State employees.
If for any reason these posts are not filled by the Contractor with permanent employees within thirty (30) days
after a post has become vacant (as scheduled in the Staffing Matrix), Conh'actor may be penalized as set forth
in Chapter Five, Section Q - Performance Guarantees, for each day or part thereof that the post is not filled.

Contractor is also expected to provide interim per diem staffing of health professionals trained to provide
health services within a correctional setting for all health services-related positions vacant beyond one (1) week
due to illness, disability, disciplinary actions, and/ or staff departures. Failure by the Contractor to fill these
posts with per diem employees while a search is being conducted for a permanent replacement may also result
in a penalty.
Contractor must also ensure that no shift is left uncovered. Attachment K - Staffing Coverage Standards
~.reflects the minimum staffing required by facility, by shift, by type of clinical staff for Contractor to avoid a
penalty under this provision. Contractor may, at its discretion and cost, fill clinical positions within higher
practice level professionals without penalty. However, the DOC will be billed at the lower level rate. Clinical
staff cannot be asked to operate outside of their scope of practice to cover a shift. Failure by the Contractor to
cover a shift will result in a penalty.
The Contractor must ensure that all personnel are licensed, certified and/ or registered in conformance with
Vermont laws and regulatory requirements. The Contractor will be responsible for· the cost of any education
required to maintain licensure and credentialing. A personnel file may be established for each employee or
subcontractor. Each professional employee's file will contain current licensure and/ or certification
documentation.
The health care staff will work as part of the multidisciplinary treatment team with Contractor's,Medical
Director and Regional Manager/Director. The health care staff will be provided with the necessary training
and resources to be proactive in addressing the inmates' health care needs, as described in Chapter Two Health Care Services.
Contractor employees will be provided with a copy of Contractor's personnel policies. All Contractor
personnel must comply with these policies and all other policies and work rules of the DOC in order to ensure
continued employment with Contractor.

- 25 -

a. Vermont Health Employees
The health care staff currently classified as Vermont State Employees assigned to the State Correctional
facilities will be permitted to retain their state employment status. The State and Contractor shall comply with
the terms of the Stipulation and Agreement between the State and the Vermont State Employees Association,
dated July 31, 1996 (Attachment I). It is expressly understood and agreed that the Contractor is not a party to
nor obligated to any contract or agreement with and between the State of Vermont and the Vermont State
Employees Association. The State agrees to hold harmless and indemnify the Contractor in any dispute
arising under the terms of said contracts andj or agreements. The DOC agrees to waive any and all penalties
related to staffing for one or more of the positions in the contract designated as being filled by a State
employee in the event of a work action or stoppage by the Vermont State Employees Association.

B. FORENSIC ACTIVITIES
The Contractor shall abide by applicable NCCHC standards for forensic activity. Contractor health care staff
shall not be responsible for participating in security activity, including shake-downs, adversarial proceedings
involving DOC staff or inmates, body cavity searches or any other security function that is inconsistent with
their role as health care staff and acceptable correctional healthcare practices.

C. PROGRAM MANAGER

Six (6) full-time Progra.m Manager(s) shall be hired by the Contractor to provide management and
administrative support to the program and serve as the intermediary between Contractor and the State.
Professional qualifications for the position of Program Manager shall include an undergraduate degree,
prderably in Health Services Administration or a minimum of five (5) years administrative experience in a
". correctional health care delivery setting.
~

The Program Manager or designee shall be on-call twenty-four (24) hours per day, seven (7) days per week,
three hundred and sixty-five (365) days per year. The Program Managers shall provide support, information
and assistance to Contractor's Medical Director and Nurse Manager, to facilita.te the accomplishment of all
contract goals.
The Program Manager shall be available to DOC facility administrators on a daily basis. Sjhe shall also
manage the day-to-day activities of the health care services program, such as recruitment and retention of staff,
staff work schedules, data gathering and reporting, budget monitoring, and the management of health care
records.
The Program Manager shall ensure the availability of professional resources and services to meet the health
care needs of the inmate population. It shall be responsibility of the Program Manager to establish an efficient
and effective multidisciplinary health care team. The Program Manager shall make available to the facility
superintendent and DOC Health Services Director a monthly health care services staffing schedule for each
facility prior to the initiation of the schedule. This report shall include the number of full-time, part-time and
relief staff by day, shift and location.
Serving as Contractor's direct liaison to the Facility Administrator and local DOC staff, the Program Manager
shall conduct monthly meetings with DOC Health Services Director to evaluate statistics, program needs,
contract issues, and coordination between custody and health care staff. Sjhe shall also be responsible for
- 26-

monitoring compliance with the DOC s policies and procedures, Contractor's health care services policies and
procedures, state and national standards and contract requirements, including compliance with the applicable
terms of the Settlement Agreement.

D. REGIONAL MANAGER/DIRECTOR
Contractor shall hire a Regional Manager/Director, who will be responsible for coordinating with Vermont
DOC Health Services Director, Facility Superintendents and Facility Executive the implementation of
programs that provide all inmates with unimpeded access to quality health services in a timely maImer,
consistent with the requirements of the Settlement Agreement. The professional requirements for the role of
Regional Manager/Director include a minimum of five (5) years experience as a registered nurse, with at least
one (1) year of clinical experience in correctional health care, and demonstrated management experience in a
health care or other setting.
The Contractor's Regional Manager/Director shall be the liaison between the DOCs central office and the
Contr'actor's central office, as well as with the DOC s Mental Health Services Contractor and other community
organizations. S/he will be responsible for the management and administration of all Vermont DOC health
care operations, with contract-wide authority to ensure that Contractor successfully meets all contractual
obligations.
S/he shall assist the Program Manager in the clinical management and evaluation of site operations,
participate in coordinating start-up activities for the contract and routinely visit all DOC facilities to evaluate
clinical and nursing programs. The Regional Manager/Director shall also assist the Program Manager and site
Nursing Managers in the development and implementation of clinical programs, provide technical assistance
in achieving and maintaining health care unit accreditation, and follow-up on site evaluation reports to ensure
corrective action has been accomplished.
"""The Regional Manager/Director Will also provide the State correctional facilities with consultation services
upon request. Consultation may be provided on a variety of topics, to include: employee health programs,
construction planning, new facility staffing plans, communicable disease management, inmate fee-for-service
and inmate copayment programs and legislative issues. In addition, s/he shall respond to emerging situations
requiring regional support action, consult with the Vermont Commissioner of Health or designee on plans,
actions, and time table of corporate or regional response and be involved in "trouble shooting" at DOC
facilities as requested or directed.

E. MEDICAL DIRECTOR
Contractor will appoint and employ a Medical Director for each site who will be the designated Responsible
Health Authority. The Medical Director shall be responsible for arranging all levels of health care and
overseeing the delivery of health care services. S/he shall work closely with the DOC Health Services
Director. All medical judgment shall rest with the Contractor's Medical Director subject to consultation with
the DOC Health Services Director on complex or unusual cases. The Medical Director shall ensure that a
physician is on-call twenty-four (24) hours per day, seven (7) days per week, three hundred and sixty-five
(365) days per year.
The Medical Director shall serve as the chairperson of the Quality Improvement Committee and monitor the
quality of care provided to the DOC. The Medical Director shall also be responsible for monitoring the
- 27 -

practice patterns of all health care staff. The Medical Director shall work closely with the Program Manager
and DOC Health Services Director to establish and maintain compliance with contract requirements, and all
national and state health care standards addressing health care in correctional facilities.

F. JOB DESCRIPTIONS
The Program Manager shall be assigned responsibility for a specific facility to coordinate the management of
the health care system for that facility with the Medical Director. To ensure the proper functioning of the
facility's health care staff, job descriptions will be developed for each position. The appropriate job description
will be reviewed with each employee. The employee will be required to acknowledge and sign off on the job
description. The job description will be used for performance reviews and will be updated annually.

G. RECRUITMENT PRACTICES
The DOC will have the opportunity participate in the selection of all senior-level positions for the contract,
including but not limited to the six Program Manager, Regional Manager/Director, Medical Directors and
Director of Nursing. After the Contractor has selected a final candidate, the Health Services Director of the
DOC may, at his/her discretion, interview the candidate. Contractor may not extend a final offer to a
candidate prior to the DOC approval.

In addition to the Contractor's clinical staff (such as registered nurses, licensed practical nurses, and physician
assistants) ideritified for each facility in the Staffing Matrix (Attachment H), it will establish a pool of
additional clinical staff to provide adequate coverage for routine clinical employee absences such as sick and
vacation leave, consistent with the Staffing Coverage Standards delineated in Attachment K. The Contractor's
.. pool will be of sufficient size to address all routine absences.

>"

""

To successfully staff its health care programs, Conti·actor is urged to utilize professional recruiters to identify
the qualifications and experience that are needed to provide quality services in the DOC environment.
Successful applicants will be selected to complement the health care program and the mission of the DOC.
Qualifications and preferences will be matched with employment criteria to identify suitable candidates for
each position. The applicant database will include:
•
•
•
•
•
•
•

credentials
licensure
certification
training
geographic preference
practice setting preference
experience

Contractor recruiters shall utilize display and classified advertising, direct mail, electronic/ internet posting,
and participation in appropriate professional conferences and health care expositions. When recru.iting for
site-specific positions, placements in local newspapers and magazines will be utilized.

'- 28 -

The State and Contractor shall coordinate recruitment efforts as needed to ensure an optimal, qualified staffing
complement is in place at each facility.

H. LICENSURE/CERTIFICATION
Contractor physicians shall meet all licensure provisions and requirements of the Vermont Medical Practice
Board. Contractor employees performing professional health care services shall be CPR-certified (including biannual re-certification) and shall maintain all necessary licensure and/ or certification to practice their
specialty. Each applicant's background, licensure/ certification, work history, and personal and professional
references shall be screened by experienced credentials specialists. Independent references shall be secured to
provide a balanced reporting of the candidate's qualifications and performance history.
The Medical Directors and Program Manager will be responsible for furnishing the State with copies of
licenses and certificates for all health care services staff, upon request. A copy will be maintained in the
employee's Contractor personnel file. In addition to verifying that all personnel have the proper license and
credentials at the time they are hired, the Contractor shall ensure that all professional licenses and credentials
are kept current and adhere to NCCHC standards. By using a chronological alert system, Contractor shall
maintain up-to-date references, copies of licenses and CPR certifications for all licensed professionals.
Documentation of current licensure and annual CPR re"certification will be made available to the DOC Health
Services Director. Such documentation shall include all information relative to any pending sanctions or
complaints filed with state or professional licensing boards.

I.

STATE OVERSIGHT

All Contractor personnel, subcontractors and agents will be required to successfully complete pre-employment
; .., security background checks and clearance by the State. Upon successful completion of the pre-employment
--security background check and clearance and acceptance of an employment offer, the Program Manager of
each facility shall immediately inform the Superintendent of the name, job title and assignment of each newlyhired health care services staff member.

,~,

"

The DOC shall have the right to reject employment and or services of any person or firm retained by
Contractor, when it is determined that such action is in the best interest of the DOC. The Superintendent shall
have the right to request the termination of any health care services staff member who fails to abide by the
facility's institutional operating procedures, or for any other just cause.
The DOC shall be responsible for providing security to Contractor personnel at all times that they are engaged
in health care duties at a state correctional facility.

J. PERFORMANCE REVIEW
Contractor shall utilize an employee evaluation system. The Program Manager and/ or the Nurse Manager
shall complete a performance assessment for each newly hired employee before the ninetieth (90 th) day of
employment. The assessment will include a recommendation to offer the employee permanent employment
status, to extend the probationary period, or to terminate the employee. The Program Manager or designee
shall complete a performance review on all employees, at least annually. An employee may, however, be
evaluated at any time, including an evaluation as to the employee's ability to help the State comply with the
- 29-

Settlement Agreement, as deemed necessary by the Contractor or State. Upon completion of the written
performance evaluation, the supervisor will schedule a meeting with the employee as part of the review. The
employee will be allowed to either agree or disagree with the evaluation, but will be required to sign and
acknowledge the evaluation. The employee will receive a copy of the evaluation; the original is forwarded to'
the central office to be filed in the employee's permanent record. The DOC shall be notified immediately of all
healt..~ care staff evaluations that reflect sub-standard performance, as well as Contractor's action plan to
immediately correct health care staff performance.
Contractor shall also participate in performance evaluations for health care staff employed by the State,
consistent with the terms of the Stipulation and Agreement between the Vermont State Employees Association
and the State (Attachment 1).

K. STAFF TRAINING AND RETENTION
Contractor shall support a well-developed staff training and professional development program to ensure a
strong foundation for performance and consistency in the provision of health care services.
The Contractor shall develop and implement a comprehensive staff retention program, including a program
specifically oriented to nursing staff. At a minimum, Contractor's retention program must require all new
staff to complete a thirty (30) day orientation period under supervision of an experienced employee. During
this thirty (30) day orientation period, all new staff will be closely supervised and will not be on a shift by
themselves. All new employees will also be required to complete a series of training modules which include
an inh'oduction to Ve'rmont's correctional system, a review of DOC s policies and procedures (including
mental health policies and protocols) and security training.
a. Orientation Training for New Employees
,.,""'"

'''"'-The Contractor orientation program for new employees is presented in three segments: (1) DOC Orientation,
(2) Contractor Employee Orientation, and (3) On-the-Job Orientation. Each employee hired after. February 1,
2005 must successfully complete all three segments of the orientation program.
1) DOC Orientation
Contractor shall commit five days of DOC orientation training for all newly-hired full-time staff (except
Nurse Managers) within six months after the hire date. Newly-hired Nurse Managers shall receive DOC
orientation training within one month after the hire date.
The State and Contractor' shall jointly develop a five-day DOC orientation training curriculum. The
curriculum shall include applicable training sessions from the Vermont Correctional Academy, as well as
training healthcare provision in a correctional setting, and other designated specialty training. The DOC
orientation training curriculum shall be developed no later than May 1, 2005. Prior to the development of
the DOC orientation training curriculum, Contractor and the DOC shall ensure that staff receive adequate
orientation either through attendance at the Vermont Correctional Academy's first week of basic training
or through some other DOC-approved process.

The Executive Health Committee, comprised of State, Contractor and Mental Health Provider representatives
is responsible for the DOC orientation training curriculum. Assistance will be provided by the DOC Human
Resources Department staff.

4

- 30-

Contractor shall work with the DOC to ensute that all employees receive an orientation to the correctional
facility within the first week of the employee's start date. The orientation shall include:
•
•
•
•
•

security policies and procedures;
health care service facilities and equipment;
schedule of services provided by the Contractor;
emergency procedures; and
all other information pertinent to the efficiency of the facility's health care services.

All employees shall be required to sign a statement that they are familiar with the institution's operating
procedures and policies.
2) Contractor Employee Orientation
Contractor employees will receive a detailed orientation to the Contractor's programs, policies, procedures
and personnel benefits. In addition to the general employee orientation, an orientation to the
administrative, medical records, pharmaceuticals, clinical services, infection control, quality improvement,
emergency procedure issues specific to the assigned DOC facility will also take place within the first week
after an employee's start date. The pharmaceutical module of the orientation program will require
licensed nurses to take a post-test used to establish the employee's knowledge base and determine if
individualized training is necessary.
3) On-the-Job Orientation
New employees B.hall receive an in-depth orientation to the post for which they are hired. The new
employee shall work with an employee who has experience in that area,allowing them to participate in the
daily routine of their new position. Each new employee will have an identified supervisor assigned.
Throughout the orientation process, new clinical staff (registered nurses, licensed practical nurses,
physician assistants, etc.) shall be required to complete a proficiency checklist, addressing the clinical skills
required for the position. The orientation will be completed when proficiency is verified by the clinical
supervisor of the new employee. Clinical proficiency verification will be completed upon the clinical
supervisor's dated signature on the proficiency checklist. The proficiency checklist shall be completed
within the first week after the employee's start date.
Although an employee may have been hired for a specific post, new employees shall be oriented to each area
in the health care services unit within one month after the employee's start date. This is done to familiarize
the employee with all aspects of the health care delivery system.
b. Ongoing Training
Contractor will seek to retain qualified staff to ensure a fully staffed, experienced employee matrix at each
facility. Contractor's continuing education program shall build on the foundation established in the
orientation process. Contractor employees shall be encouraged to further their professional development by
attending seminars, lectures and conferences. The Contractor shall provide all health care staff with paid time
off to attend continuing education classes and training, in compliance with NCCHC standards.
Quality Improvement studies, incident reports, inmate grievances and infection control review findings will be
used to identify educational topics specifically needed by a facility. The Contractor educational program will
also contain specific programs designed to acquaint employees with Contractor's goals and objectives, policies
- 31 -

and procedures, nursing protocols and programs. Contractor's central office personnel will be utilized to
augment these educational programs.
Contractor shall provide a health care reference library at each major health care services area. The library will
contain professional reference books and current periodicals. Reference materials will include but not be
limited to:

•
•
•
•
•

National Commission on Contractor Health Standards for Health Services in State Contractor Facilities;
lllustrated Medical Dictionary;
Physicians Desk Reference;
Textbookof Medical-Surgical Nursing; and
Current Medical Diagnosis and Treatment.

The Contractor shall develop an employee grievance resolution policy and process that provides all Contractor
staff with a confidential forum to address work-related issues. Quality Assurance/Improvement reports to
the DOC will describe the number and kind of employee grievances by facility on a monthly basis.

- 32-

IV.

ANCILLARY SERVICES

A. CORRECTION STAFF EDUCATION

Contractor shall provide training to all DOC Correctional Officers with respect to basic identification of
inmates requiring immediate medical attention and shall be consistent with NCCHC standards. This will
include training with regard to symptom recognition (shortness of breath, choking, bleeding, etc.) and the
appropriate steps for h'iaging and obtaining medical services for the inmate on an urgent or emergent basis.
Training will include in-person orientations and written materials.
Contractor shall conduct in-service education and training sessions for Corrections staff, at each facility, on a
quarterly basis. The training curricula will be approved by DOCs Health Services Director and should
include, at a minimum:
•
•
•
•
•
•
•
•
•
•
•
•
•
....
•
,;,.
-.
•
•
•

administration of first aid;
recognizing the need for emergency treahnent;
recognizing acute manifestations of chronic illnesses;
recognizing chronic medical and disabling conditions;
recognizing signs and symptoms of mental illness and psychological trauma;
recognizing sign and symptoms of traumatic brain injury;
recognizing signs and symptoms of dementia;
medication side-effects and administration;
infectious and communicable diseases;
cardiopulmonary' resuscitation;
recognizing suicidal behavior and procedures/protocols for suicide prevention;
smoking cessation;
stress management;
hepatitis A, hepatitis B and hepatitis C;
HIV;
Tuberculosis;
utilization of the Contractor's services; and
procedures for the delivery of emergency, acute and chronic illness services by Contractor staff.

The Contractor will also develop, in conjunction with the DOC Mental Health Provider, education on mental
health topics as requested by the State. These topiCS may include:
•
•
•

mental health;
substance abuse; and
suicide prevention.

B. STAFF VACCINATIONS

The Contractor is responsible for the provision and administration of Hepatitis B vaccine and TB testing items
for use with security staff and/ or other staff who are identified as being at significant risk of infection (as
designated under the OSHA Blood-borne Pathogens mandate). Contractor's nurses will give these injections
and maintain appropriate documentation of their administration.

- 33 -

In addition, the Contractor's nurses will administer diphtheria-tetanus vaccines when (1) injuries require a
booster and (2) on a preventative basis (every ten (10) years) to security staff. The costs for such services and
associated vaccines will be based upon the Contractor's accepted price for this service, and paid in accordance
with the Additional Monthly Charges procedure delineated in Attachment B - Payment Provisions.

C. COORDINATION WITH THE DEPARTMENT OF HEALTH

The Contractor will be required to coordinate and work collaboratively with the Vermont Department of
Health. The Contractor will be expected to cooperate with the any program or training module offered by the
Vermont Department of Health. The Department of Health will provide on-going guidance to the Contractor
and DOC on a variety of issues including the following:
•
•
•
•
•
•

quality assurance activities;
infection control;
critical incident investigations;
detection and prevention of HN/ AIDS;
dissemination of public health information and education for inmates and staff; and
response to public health threats.

In addition, the Contractor will coordinate and work collaboratively with the Vermont Department of Health
in its implementation of an independent monitoring process for Quality Assurance and Quality Improvement.

- 34-

V.

Administrative Services

A. POLICIES AND PROCEDURES

The Contractor shall develop site-specific policies and procedures, which will be reviewed annually by the
DOC. An electronic copy of each facility's policies and procedures shall be sent to the DOC within the two (2)
weeks of contract implementation, February 1, 2005. These policies and procedures will be posted on the
DOCs website.
The Conh'actor's policies and procedures are subordinate to the DOC s policies and procedures. The DOC will
review all Contractor policies and procedures to ensure compliance with all federal and state laws and
regulations, NCCHC standards and all DOC policies and procedures (including mental health policies and
procedures). As necessary, the DOC will request changes to the Contractor's policies and procedures.
Completion of formal policy review and development shall occur within four (4) months of February 1, 2005.
Compliance with DOC policies and procedures will be monitored through CQI reporting and through
scheduled and unscheduled audits by the Department or the Vermont Department of Health.

B. CONTRACT IMPLEMENTATION AND INITIATION ORIENTATION
a.

Implementation

As part of its proposaCConh'actor submitted a Gantt chart summarizing key implementation tasks and
anticipated timeframes for the completion of these tasks. In consultation with the DOC, Contractor developed
a more detailed implementation plan delineating key milestones and associated start and end dates for the
period prior to contract implementation - February 1, 2005. This revised implementation plan is included as
."·.Attachment G of the contract.
Contractor shall meet with DOC representatives weekly to report implementation status, issues and adherence
to implementation timeframes reflected in Attachment G. The State and/ or its designees shall monitor
Conh'actor's readiness throughout the implementation period, and may issue requests for corrective action
plans, as appropriate, should Contractor fail to meet key milestones that jeopardize successful implementation
by February 1, 2005,
In the event that Contractor fails to be fully operational by contract implementation, February 1, 2005,
Contractor may be charged up to $25,000 per day until full operational status has been achieved, On February
1,2005, the Vermont DOC Administration will notify Contractor in writing of its assessment of operational
status - fully operational or non-compliant. Compliance shall be based upon completion of the key milestones
in Attachment G, as determined by the VDOC. The DOC shall detail all compliance shortfalls by facility and
function. Contractor will develop detailed corrective action plans for all non-compliant facilities and functions
within five calendar days of receipt of the DOC operational assessment letter.
Once the DOC has notified Contractor in writing that full operational status has been achieved, this provision
(and its associated performance guarantee) will no longer be applicable for the remainder of the contract.

·35 .

b. Orientation
The State will review all proposed policies, procedures and program materials in advance of Contractor's use.
Contractor central office personnel will conduct an orientation program for the State addressing Contractor's
policies, procedures, programs and personnel benefits in January 2005. All Contractor employees and at least
one DOC representative will attend this pre-contract initiation orientation program.
Contractor's six (6) Program Managers, Regional Administrator, Medical Director, and Director of Nursing,
will be on-site at the time of conh'act initiation to assist on-site personnel and ensure the proper
implementation of Conh'actor's programs. Contractor's Quality Improvement Director and Information
Systems Director will be on call and available as needed during the contract initiation period.

C. CONSULTATION

The Program Managers shall provide support, information and assistance to local management personnel,
including the Contractor's Medical Director, to facilitate the accomplishment of all contract goals and will meet
regularly with the DOC administrators to discuss health services and contract issues. The Contractor's
Regional Manager/Director will be responsible for coordinating with representatives of the DOC, especially
facility management staff (e.g., Superintendents, assistants and Supervisors of Security), to implement
programs that provide all inmates with unimpeded access to health care services in a timely manner, and are
consistent with the requirements of the Settlement Agreement.
The Contractor's Regidnal Manager/Director will provide the State correctional facilities with consultation
services upon request. Consultation may be provided on a variety of topics, to include: employee health
programs, construction planning, new facility staffing plans, communicable disease management, inmate feefor-service and inmate copayment programs and legislative issues. Consultation will include furnishing the
{,;:. DOC Health Services Director with copies of all sub-contracted services and a rationale for the selection of
·-each vendor.

D. MEDICAL RECORDS
a. . General

Contractor shall maintain a problem-oriented health record, consistent with state regulations and community
standards of practice. The health record will include medical, dental, chemical dependency, and mental health
care information, and will be stored separately from custody records.
A health record will be initiated during the inmate's first health care encounter and shall contain complete and·
accurate records of health care services provided during the individual's incarceration.
An inmate's health record will be available for reference during health care encounters. Documentation will be
in the SOAP format, legible and completed with the date, time and place of the encounter. The health care
provider's signature and title will be recorded for each encounter.
Each form and document in the health record shall contain identification information including the inmate's
name, race, sex, date of birth, and the name of the facility presently maintaining the inmate's health record.
- 36-

All outside health services, such as laboratory results, or physician consultation reports, will be filed as part of
each inmate's permanent health care record.
The Contractor must ensure that health records are kept current. Each encounter between a health care
provider and an inmate must be documented in the health record by the end of each staff shift to ensure that
the providers coming onto the next shift are aware of the medical status of any inmate treated during the prior
shift.
Health records for inmates transferred to other facilities within the State of Vermont must be securely
tmnsferred to the receiving facility within four (4) hours of the inmates transfer. Inmates transferred to out-ofstate facilities must have complete health records physically accompany them on the out-of-state tramer.
The health records of discharged inmates will be maintained in accordance with the laws of the State of
Vermont and policies of the DOC. Existing health records will be incorporated into the new health record on
an inmate's return to the DOC from both the community and from out-of-state facilities.
At a minimum" the standardized health care record shall contain the following information:

•
•
•
•
•

•
•

•

•
•
•
•
•
•
•
•
•
•

•
•
•

identifying information (i.e.. inmate name, date of birth, gender)
problem list containing medical and mental health diagnoses and treatments as well as known allergies;
completed intake/ receiving screening form;
health assessment form;
progress (SOAP) notes of all significant findings, diagnoses, treatments and referrals;
provider orders;····
accommodations requested by or offered to inmates with special needs;
results of screenings and assessments and treatment plans developed to address substance abuse and
addiction issues;
inmate requests for health care services, including illnesses and injuries;
medications administration records;
reports of laboratory, radiology and other diagnostic studies;
informed consent and refusal forms;
release of information forms;
place, date and time of health care encounters;
health provider's name and title;
hospital reports and discharge summaries;
intra-system and inter-system transfer surrunaries;
specialized treatment plans;
consultation forms;
Health Services reports;
immunization records, if applicable;
inmate medical grievance forms; and
documentation of all medical, dental and mental health care services provided, whether from inside or
outside the facility.

- 37 -

b. HIPAA Compliance
To comply with standards promulgated under the Health Insurance Portability and Accountability Act of 1996
(HIPAA), including the Standards for the Privacy of Individually Identifiable Health Information, Contractor
must enter into a Business Associate's Agreement with the DOC (an example of Vermont's template Business
Associate's Agreement is included as Attachment E).
Health records for inmates at each facility must be maintained in a secure location consistent with the
confidentiality and security needs of the institution. Health records shall be maintained in a confidential and
HIPAA-compliant manner at all times consistent with the Agency of Human Services Rule #96-23 (Attachment
F). The Conti'actor must ensure that all health records are kept secure and intact. Health records and reports
are, and will remain, the property of the DOC.
Because PHI may be used or disclosed without authorization for specialized government functions, a
correctional institution or a law enforcement official with lawful custody of an inmate may have access to PHI
for the health and safety of such individual, other inmates, officers or other employees at the correctional
institution, or persons responsible for such inmate's transportation or otherwise for the administration and
maintenance of the safety, security, and good order of the correctional institution. Information necessary for
the classification, security and control of inmates will be shared with the appropriate Corrections personnel.
In any criminal or civil litigation where the physical or mental condition of an inmate is at issue, Contractor
will provide full and unrestricted access to and copies of the appropriate health care record to the State within
the scope of legal and regulatory requirements and in accordance with the DOCs policies, procedures and
directives.

E. TREATMENT PROTOCOLS
,"_ The Contractor shall employ treatment protocols for chronic conditions common among the Vermont inmate
""population. The treatment protocols should be designed and implemented tb ensure appropriate utilization of
clinically proven, cost effective treatment modalities. The protocols should be further implemented in a
manner that ensures that treatment is provided in a generally consistent manner for all inmates requiring
medical care for a particular condition. The protocols used should be consistent with those of national level
organizations that develop clinical protocols for their own use and as guides for others, including those
developed by federally-qualified Health Maintenance Organizations. The use of NCCHS clinical guidelines
for chronic disease management in correctional institutions is also recommended.

F. CONTINUOUS QUALITY IMPROVEMENT PROGRAM
Contractor shall implement a continuous quality improvement program as set forth by NCCHC standards.
Contractor's CQI shall address health, environmental and safety issues. The Contractor. shall perform quality
assurance measurements, compile reports, and monitor the compliance with the CQI program and the
contract. The format of such reports generated for the DOC will be subject to approval by the DOC Health
Services Director.
All CQI reports will be received within fifteen (15) working days from the close of each month. Failure by the
Contractor to provide such reports within the prescribed time period will result in a penalty of $1,000 per
month for each month that the report is not received. (See "Performance Guarantees"- Chapter 5, Section Q.)
- 38-

The CQI program will be overseen by a QI Committee, which will be chaired by the Contractor's Medical
Director. The QI Committee will meet monthly and will be attended by the nursing staff, dental staff, medical
records staff and Contractor administrative personneL The QI Committee will review all reports prepared by
the Contractor for the DOC.
The multi-disciplinary QI committee is also responsible for monitoring inmate health, the control and
prevention of communicable diseases, and safety and sanitation in the facility environment. The primary
purpose of the committee is to identify problems and opportunities for improvement, based upon the data
collected in the monitoring process, including from inmate grievances. The Contractor shall develop a written
Quality Improvement Manual that includes policies and procedures for all aspects of the QI program. A copy
of the manual shall be approved by the DOC Health Services Director no later than fifteen (15) days prior to
the start of service delivery under this contract. Updates to the manual shall be provided to the DOC Health
Services Director on a quarterly basis thereafter. The Contractor's QI manual will be used to provide inservice training to its staff.
In addition to monthly QI committee meetings, quarterly meetings will be conducted with the DOC central
office through the Executive Health Services Committee (EHSC) to communicate CQI findings and to describe
actions taken to resolve problems that are specific to health care services. The EHSC will include the DOCs
Health Services Director, State Chief Nursing Officer, Contractor's Program Manager, and Contractor's
Medical Director.
The Executive Health Committee will conduct monitoring and evaluating activities to ensure operation of the
ongoing CQI proble;.n~:solvingmechanism designed to monitor and improve inmate health. The Executive
Health Committee will conduct mortality and morbidity reviews and special case reviews and will assure
timely communication and resolution of problems as they arise. The Committee may establish work groups to
address specific clinical or systems issues. In addition, all policies and procedures related to the delivery of
,-.- health care services will be reviewed by the Executive Health Committee.
?""-

The comprehensive CQI shall contain the following components:
•
•
•
•
•

risk management;
infection control;
utilization of services and cost containment;
inmate grievances; and
quality monitoring.

1) RISK MANAGEMENT - Contractor shall establish a logical and thorough system of policies and
procedures to minimize exposure to liability. Risk management activities focus on the identification of
clinical events which have or may have the potential of placing the inmate, health care provider, or the
facility at risk. Identified risk areas are investigated and analyzed to develop policies and procedures that
reduce risk and maintain a safe clinical setting. The CQI shall include a safety component to provide a safe
environment for inmates, employees and visitors. Contractor shall work with DOC officials to establish a
process to systematically monitor and evaluate the environment. The QI committee will work to maintain
a safe environment and reduce the risk of accidental injuries.
2) INFECTION CONTROL - Contractor's infection control policies and procedures shall focus on the
prevention, identification and control of diseases acquired in the facility setting or brought in from the
outside community. The infection control program will address hand washing, housekeeping,
- 39 -

decontamination, disinfection and sterilization of equipment and supplies, medical isolation, infectious
and parasitic laundry, infectious waste, pest control and parasite infected environments. The primary
functions of the infection conh'ol program are:
•
•
•
•
•
•
•

the management of communicable disease surveillance and treatment;
daily reading of tuberculosis tests;
reporting of communicable diseases and conditions (e.g., tuberculosis, sexually transmitted diseases,
and hepatitis);
collection, evaluation and reporting of epidemiological data for trends;
development of effective systems for identification, prevention and control of communicable disease;
ensure adequate community follow-up and coordination after inmates are released from the facility;
and
provide education to inmates and Contractor employees on communicable diseases, including
symptoms, transmission and analysis.

Contractor's infection control program will emphasize surveillance activities to facilitate the identification,
prevention and conh'ol of communicable diseases. Surveillance activities are also used to identify the
health education needs of all who live and work in the DOC. Contractor's infection control volume data
reporting forms will be designed to facilitate the collection of data on a variety of infection conh'ol issues,
to include:
•
•
•
•
•

~

inmates testing positive for venereal disease;
inmates testing positive for HIV;
inmates diagnosed with AIDS;
irunates testing"positive for TB; and
inmates testing positive for hepatitis.

Contractor shall develop an extensive infection control manual and protocols to provide a resource for onsite staff. A copy of the infection control manual will be placed in each nursing area.
3) UTILIZATION OF SERVICES - COST CONTAINMENT - Contractor will establish a utilization review
program to use of health care resources in a cost-effective manner. Policies and procedures will be
established to ensure the delivery of health care services in an effective and efficient manner, with an
emphasis placed on the triage process to appropriately channel inmates to health care providers who can
appropriately evaluate and treat the presenting condition.
Contractor personnel shall collect and monitor statistical data to detect potential problems. Volume data
reporting forms will be used to report data and to track the utilization of health care services on a year-todate basis. Significant variances will be reviewed for problem identification. Contractor's central office
personnel will monitor the utilization of all health care services provided off-site, as compared to national
data on incarcerated populations, and will be readily available for telephone consultations. Contractor
shall provide State Administrators with a report identifying those inmates transferred off-site to the
hospital emergency department, and a status report on all inmates in local hospitals and the DOC
infirmary. Contractor's volume data reporting forms will also be used to prepare a monthly narrative
report to the DOC Health Services Director on the types and numbers of services provided, including:
•
•
•
•

intake medical screenings
health assessments
inmate requests for service inmates seen at nursing sick call
inmates seen by the physician
- 40-

•
•
•
•
•
•
•
•
•
•
•
•
•

inmates seen by the nurse practitioner
inmates seen by the dentist
inmates seen by the psychiatrist
inmates seen by the psychiah·ic nurse practitioner
infirmary admissions, patient days, average length of stay
off-site hospital admissions
medical specialty consultation referrals
diagnostic studies
percentage of inmates on medications
inmate mortality
health care services manpower report, hours worked at each post
problems identified and actions taken or planned, with timeframes to resolve them,
number and type of employee grievances by facility

Each month Contractor shall provide the State Administrators with a report on the costs accrued and/ or
paid for all outside andcoff-site treatment for each affected inmate. In addition, a cumulative total cost will
also be provided for the contract term.
Conh·actor shall use on-site pre-admission testing prior to hospital admission, second opinions for all
planned major surgery, and capitation or hourly type subcontracts with medical specialty providers. With
the exception of life threatening emergencies, all hospitalizations will be pre-authorized and accompanied
by concurrent review designed to minimize the necessary length of stay in the hospital. Contractor shall
assure that the Medical Director or designee may interrupt this process should it become necessary to treat
an inmate in a m-;)re emergent fashion. Retrospective reviews will also be completed.
4) ISSUE RESOLUTION AND GRIEVANCE PROCESS - When inmates believe they have not received a level
or type of health care to which they are otherwise entitled, they shall have access to a resolution process
which will expedite answers to their questions and additional care as determined. The Contractor shall
have policies and procedures for a formal process to respond to these inmate issues. The contractor shall
ensure that all inmates have access to this process in writing and that they understand it. In cases where "a
disability may limit an inmate's understanding of the process, accommodations will be provided. A
standardized form shall be used for the filing of inmate issues, unless disability accommodations require
other means. Inmates may request, and must be provided assistance, in completing the form.
The Department will develop an Ombudsman program (separate from the Contractor's issue resolution
process) to ensure the inmates, their families, and advocacy organizations in the community have access to
an individual who can assist them in the resolution of inmate complaints about their health care. The
Contractor shall cooperate with the Ombudsman in resolving grievances and other issues. This. program is
not seen as a replacing or pre-empting the DOC's grievance process as relates to health care complaints.
The Contractor shall propose an issue resolution process that at a minimum:
•
•
•

includes policies and procedures that are consistent with the Department's policies and procedures;
coordinates with DOC's Ombudsman program; and
ensures the Nurse Manager for each facility is available at least once weekly to meet with the
Ombudsman and inmates.

The Nurse Manager shall be the initial arbiter of all issues and shall work with inmates to resolve
complaints and issues. The Nurse Manager shall have an excellent working relationship with the
- 41 -

Ombudsman, who will act as a mediator between the inmate and the Contractor to resolve issues and
grievances.
All issues received by the Contractor must be entered into an automated issue log. The log must include at
a minimum:
•
•
•
•
•
•

the date the issue was filed;
the name and identification number of the inmate filing the issue;
the nature of the issue;
the categorization of the issue (routine or urgent);
any investigation conducted by the Contractor; and
the resolution of the issue and date of resolution.

Inmates may file a formal grievance with the DOC at any time. All routine and urgent grievances will be
resolved by the DOC in accordance with its policies and procedures. Urgent grievances are defined as
those complaints that involve an immediate need on the part of the inmate for health care services to
prevent permanent disability or loss of bodily functions, or for severe pain. Urgent grievances shall be
resolved in consultation with the Contractor's Medical Director or his/her designee.
The inmate will be notified in writing of the resolution of the grievance in accordance with DOC policies
and procedures.
The Contractor must provide monthly reports to the DOC on the number, categorization (routine or
urgent), type and'disposition of all issues it receives from inmates; and provide Facility Superintendents
on-going access to the automated issues log.
5) QUALITY MONITORING ~ Contractor's unit based CQI will monitor, evaluate and improve health care
services delivery. It will also provide its data, data analyses, and performance improvement plans to the
Vermont Department of Health for use in its independent DOC Quality Assurance/ Improvement process.
Contractor has developed monitoring tools designed to meet the specific needs of the DOC. The
monitoring tools address the following areas:
•

Special inmate events which warrant further evaluation based on the potential of a serious outcome.
The review of special inmate events focuses on both health care management and continuity of care.

•

Health care records review, with special attention given to discharge summaries, laboratory and
diagnostic tests, the appropriate use of protocols, processing of medical records, medical record
retention processes and compliance with national standards.

•

Physician record reviews performed on a specified number of randomly selected medical records by a
physician to review the treatment being provided, determine if it is appropriate, and make changes in
the individualized treatment plan. A summary of the medical record reviews will be presented each
month to the CQI committee by the Medical Director.

•

Focused studies performed to monitor specific areas of concern for the purpose of problem
identification in a variety of functional areas such as medication reviews, contract services and chronic
management, including:
chest pain
consultations
dental services
- 42 -

EKG
history and physicals
intake screening
medical record
medication administration
mortality review
patient education
suicide precautions

G. INTERFACE WITH DOCS MENTAL HEALTH SERVICES PROVIDER
The Contractor shall establish procedures to ensure an ongoing active interface with the DOCs
mental health provider system. The Contractor shall designate a liaison to work with mental health providers
in establishingroutine and emergency lines of communication and developing procedures to ensure that
ongoing coordination of services occurs. The purpose of the interface between the parties is to ensure
coordination of care occurs for inmates being treated for both physical and mental health problems. The
Contractor shall establish treatment teams in conjunction with the mental health providers as appropriate and
necessary to ensure an efficient and effective level of care coordination.
a. Alcohol and Substance Abuse Services
Inmates admitted to the DOC under the influence of drugs and/ or alcohol and those with significant histories
related to the use of drugs and alcohol will be referred for further substance abuse counseling. The counseling
will be used to evaluate the inmate and determine the need for substance abuse counseling and treatment.
This process shall include protocols that involve the DOC Mental Health Provider in inmate evaluation and, if
necessary, treatment plan development. Contractor shall assist in discharge planning in anticipation of release
,,- from the DOC.
0-

b. Detoxification
Incapacitated persons brought to a correctional facility pursuant to 33 V.s.A. Section 708 (d)(l) & (2) shall be
screened by medical staff. Treatment related to their detoxification shall be provided by the Contractor
according to protocols agreed upon by the Contractor and the State. Detoxification treatments shall include the
DOC Mental Health Provider in inmate evaluation and, if necessary, treatment plan development. Individuals
committed under the influence of alcohol or drugs will be kept under close observation. The nursing staff will
utilize established nursing protocols to monitor intoxicated individuals during the detoxification period. If the
individual indicates a history or exhibits signs oEan intense detoxification period, a physician will evaluate the
inmate to determine whether hospitalization for evaluation and treatment is appropriate.
c. Mental Health Services
The DOCs contractual and State mental health care providers shall provide all services related to the mental
health needs of inmates, including assessment, diagnosis and treatment. Contractor shall support these
activities as agreed upon with the State and refer inmates to mental health care providers as necessary.
Contractor shall work collaboratively and cooperatively with these providers to ensure open lines of
communication and comprehensive care for inmates receiving medical and mental health care services. The
Contractor's Medical Director and the DOC Mental Health Provider's Psychiatric Director shall ensure that
inmates are not referred for mental health treatment in lieu of needed and appropriate medical services.
- 43 -

Weekly meetings shall be held to discuss treatment plans in cases involving both the Contractor and DOC
Mental Health Provider. Meeting minutes documenting all discussion and decisions shall be sent to the
Executive Health Committee. Any unresolved disagreements over the appropriate course of treatment for an
inmate shall be forwarded to the Executive Health Committee for final determination.
d. Crisis Intervention and Suicide Prevention
Contractor shall assist the DOC Mental Health Provider in providing training for the correctional and health
care services staff in the identification of signs and symptoms of suicidal behavior. Contractor shall participate
in the continued development and implementation of suicide prevention programs with the DOC Mental
Health Provider.
When an inmate is suspected of being at risk of harm to himself/herself, Contractor shall (1) contact the DOC
Mental Health Provider or other designated provider, (2) coordinate with the State for the close observation of
the inmate for suicidal behavior until a mental health care provider is able to assess the inmate's mental health
status, and (3) assist other personnel in safety-related activities. Contractor shall document all relevant
information and interactions with suicidal inmates and include relevant information in the inmate's medical
chart.

H. DISASTER MANAGEMENT

Contractor shall wor.k in conjunction with the DOC to develop a health care disaster plan for each facility and
to ensure that the roles"of Contractor staff are clearly understood in disaster situations. The health care
services disaster plan will be coordinated with the facility's disaster plan to provide an effective and effective
and efficient response to all disaster situations. Contractor personnel will work cooperatively with State
correctional facility personnel to establish evacuation and disaster policies and procedures specifically for the
, ..- DOC. The facility-specific policies and procedures will be used for in-service training.

""

I.

MANAGEMENT INFORMATION SYSTEM

Within thirty (30) days of commencement of the contract, Contractor shall evaluate the system in use by the
DOC. Contractor will report to the DOC whether historical data maintained on the current system must be
converted to be used by Contractor. If necessary, data conversion of all existing files must be completed
within seven (7) days of contract commencement, and within twenty-four (24) helurs for the seven (7) day
period before contract commencement.
The principal data collection tool is the patient encounter log. Specified inmate encounters are recorded in the
log on a daily basis, including:
•
•
•
•
•

patient scheduling
chronic tracking and follow-up
infectious inmate follow-up
statistical workload summary
input for clinical quality improvement

- 44-

Additional data required under this conti'act include:
•
•
•
•
•
•
•
•

monthly volume and types of services
utilization review (input to the review committee)
comparison with prior periods and target work load plans
pharmacy dispensing and utilization
manpower utilization data system
clinical CQI
diagnostic aggregate data
issue/complaint log data

Data collection from each site and compilation for the region will be supervised by the Program Manager.
Monthly summary reports will be generated and made available for discussion at each QI Committee meeting.
Significant variations will be investigated and discussed by the committee, with the goal of modifying
utilization trends to identify problems at an early stage.
Any enhancement by the Contractor of its corporate management information systems shall be made available
to the State within six (6) months of implementation at any correctional facilities operated by the Contractor.
Any software purchased specifically for operations within the State, along with all historical data files shall
remain the property of the State. In the event that the Contractor ceases operations under this contract,
software, management information systems, and data files used in the daily management of the program shall
remain available and accessible to the State for a period not to exceed six (6) months.

J.

PURCHASING PROCEDURES

Contractor shall assume total responsibility for purchasing all perishable and non-perishable medical and
pharmaceutical supplies. Every effort will be made to purchase medical supplies from Vermont vendors. The
~jndividuql authorized to conduct Contractor's contracted purchasing program shall be the assigned Program
Manager. The Program Manager shall act as the day-to-day liaison between the DOC- and Contractor
regarding purchasing issues.

K. INSURANCE

Refer to Attachment C, Section 6 and Attachment D.

L. ACCREDITATION PLAN
The Contractor's accreditation plan must include the folloWing elements:
•

Contractor shall survey and assess the NCCHC accreditation potential of any non-accredited sites (or new
sites) within ninety (90) days of commencement of the contract (or new site)

•

Non-accredited sites must receive at least provisional accreditation within eight (8) months of
commencement of the contract (or opening of a new site)

•

Contractor shall maintain accreditation for all accredited sites

- 45 -

Contractor's Regional Manager/Director (or designee) will collaborate with the Contractor's Program
Manager, Medical Director, Director of Nursing, and DOC administrators to ensure that all policies,
procedures and programs are in compliance with the most current NCCHC standards for health care services
in jails and prisons. In addition, the Regional Manager/Director (or designee) will perform on-site
accreditation reviews periodically tlu'oughout the contract to ensure continued standards compliance. The
Regional Manager/Director (or designee) will instruct the State staff in the proper use of the evaluation tooL
The evaluation tool will be used when establishing or revising policies and procedures, to ensure continued
compliance with NCCHC standards. Contractor will establish and implement a corrective action plan with
specific completion dates and benchmarks for any discrepancies or shortcomings regarding standards
compliance. The corrective action plan and all necessary documentation will be submitted to the State for
review.
If the parties agree that subsequent changes in the NCCHC standards have significant cost implications, the
parties reserve the right to amend the contract.

M. OTHER OPERATIONAL AND FINANCIAL DATA REPORTING
Contractor must submit a series of operational and financial reports, using report formats and transmission
methods as defined in collaboration with the State. All annual reporting shall be according to the State's Fiscal
Year (July 1 to June 30). Most annual and quarterly reports are due from the Contractor and any
subcontractors to the DOC within forty-five (45) days after the end of each reporting period. Facility-specific
operational and financial reports must be submitted, as well as an aggregated report for the entire system.
The State reserves the right to request additional or different reporting information from the Contractor
throughout the term of the contract, on either an ad hoc or regular basis.

,
'""The DOC and the Vermont Department of Healthwill conduct scheduled and unscheduled contract audits to
verify and validate the delivery of services provided by the Contractor. These audits will be scheduled at least
one week in advance. The Contractor shall make available detailed personnel retords, attendance data, staff
vacancy reports and other relevant information as required by the audit team.
a. Operational Reports
Contractor shall prepare the following operational reports, using State-approved templates. These reports are
due by the fifteenth (15 th) of each month for the previous month:
Monthly
•

Contractor Operational Variance Reports - Contractor shall compile a comparison by facility (as well as a
summary report of all facilities) of projected versus actual units of services provided, by service type. For
all variances greater than ten (10) percent, an explanation of the negative or positive variance must
accompany the report. The following are required in the variance reports:
Number of receiving screenings, initial and annual history and physical examinations, and initial
dental screenings processed in the period.
Number of units of other health care services rendered by major category of service (e.g., inpatient
hospital days, outpatient hospital procedures, infirmary days, primary care provider encounters,
- 46-

specialist physician encounters, surgical procedures, pharmaceutical prescriptions dispensed, and
dental procedures) during the period.
"

Service Disposition/Lag Reports - Contractor shall report on the:
Number of sick call requests received, the number of requests not requiring a health care encounter or
denied, and the number of days from an irnnate's initial sick call request until a health care encounter
occurs.

•

Inmate Complaints/ Grievances - Summary of inmate complaints/ grievances by category (urgent or
routine), type and disposition. Data shall also be provided to DOC to enable it to determine if irnnate
grievances were resolved timely.

Quarterly
•

QI Reports - As described in the preceding section.

•

External Physician Referral Reports - The number of referrals to outside physician providers by major
specialty (cardiologist, pulrnonology, gastroenterology, gynecolOgy, neurology, nephrology, oncology and
hematology, ophthalmology, urology, general surgeons, specialty surgeons, infectious diseases,
orthopedics, rheumatology, endocrinology, and other) with associated diagnoses will be tracked and
reported by the Contractor. Included in the report, will be the number of days from initial referral to an
external provider until the encounter occurs.

•

External Facility70ther Providers Reports - The number of referrals to outside facility/other providers by
type (hospitals, outpatient surgery centers, others) with associated diagnoses will be tracked and reported
by the Contractor. Included in the report, will be the number of days from initial referral to an external
provider for a specific clinical service to the date the service is provided.

(;."_"

Dental Utilization Reports - The number of dental encounters by type (emergency, routine) and facility, as
well as the number of inmates on the dental service waiting list within each facility. Included in the report
will be the number of days from initial referral for a specific dental service to the time that the dental
service is rendered.

"

Inmate Patient Demographic Profile Report - A summary of inmate demographics under treatment (age,
sex, race, etc.), along with the healthcare services delivered will be reported. Included in this report will be
data specific to the chronic and convalescent populations, and the number of special needs/chronic
treatment plans developed.

•

Infirmary Admissions Reports - Number of infirmary admissions and days by diagnosis.

•

Food Service Worker Clearance Reports - Number of inmate food service worker medical clearances
performed.

•

Staff Vaccinations Reports - Number of staff vaccinations provided by type.

b. Financial Reporting
The Contractor will submit quarterly and annual financial statements, using state-furnished templates, which
specifically report the Contractor's performance under its contract with the Department. The statements will
be prepared in accordance with generally accepted accounting procedures. In addition to the contract specific
financial statements, the Contractor will also submit the entire organization's quarterly and annual financial
- 47 -

statements. Quarterly reports are due forty-five (45) days after quarter end close. Final annual financial
statements are due ninety (90) days after the close of the contract period.
Three months prior to the end of the conh'act term, the Conh'actor shall submit the next year's annual budget,
including case load and service volume assumptions, annual cash plan and profit and loss statement to the
State for review and approval for the following conh'act year.

N. CLAIMS PROCESSING
The Contractor must have a claims processing system that can accurately adjudicate all types of provider
claims, including hospitals, physicians, ancillary providers, etc.
Clean claims must be processed (reimbursed, denied or responded to) within thirty (30) days of receipt. The
Contractor must have in place a process for specifying missing information when provider claims are denied
due to incomplete status. All claim denials must include detailed information on the reasons for the denial
and the provider's right to appeal.
Failure to promptly reconcile and pay clean hospitalj community-based provider claims within thirty (30) days
of the Contractor's receipt of the claim may be grounds for financial penalties (see Chapter 5, Section Q)
and/ or contract termination. All provider claims thirty (30) days or more in arrears shall be reported to the
DOC as a part of the Contractor's monthly quality improvement reporting.
Pharmacy claims may be processed by the Contractor's pharmacy vendor.

O. INMATE TRANSFERS BETWEEN VERMONT DOC FACILITIES AND OUT-OF-STATE FACILITIES
a. Transfers between Vermont DOC Facilities
The protocol for preparation of clinical information for inmate transfers between Vermont DOC facilities
includes:
•

Preparation of the medical record inserted into a plain brown folder placed in a sealed envelope with the
inmate's name and the phrase "CONFIDENTIAL - MEDICAL/ MENTAL HEALTH INFORMATION"

•

A supply of all prescription medications ranging from one (1) to seven (7) days or whatever quantity
remains on the nunate's prescription card

These materials are to be provided by the sending facility to the DOC transport team at the time of the
inmate's transfer.
b. Transfers Out-Of-State
The protocol for preparation of clinical information for inmate transfers between the Vermont DOC and
another state's facility includes:
•

Assembly of a photo-copy of the medical and mental health records which include all records for a
minimum of one (1) year from the data of the out-of-state (OOS) medical clearance (Le., a medical clearance
date of 10/25/04 will include all medical and mental health records from 10/25/03). Diagnostic and
- 48 -

laboratory results for up to five (5) years are also to be sent with the health records. The following health
care record documents must be included:
-

.

problem list
current history and physical
all information related to conditions currently under treatment
relevant labs and data
chronic care clinic notes and notes relating to specific conditions
copy of immunization record
TB test results writing in millimeter
mental health care information including mental health evaluation, treatment plan, and notes related to
any ongoing clinical care

•

Conh'actor shall retain the original health care record documents, but make a copy to be inserted into a
plain brown folder placed in a sealed envelope with the inmate's name and the phrase "CONFIDENTIALMEDICAL/MENTAL HEALTH INFORMATION." The records designated for OOS will be organized in a
multi-part medical chart folder by the "sending facility" (a sending facility is defined as the Vermont DOC
facility where the inmate was lodged at the time the medical clearance was performed.) Each Vermont
DOC facility health center that performs OOS transfers will be provided with such folders (available for reorder from the DOC Central Office).

•

The photocopied medical record assembled into the folder must physically accompany the inmate upon his
transfer out-of-state. Out-of-state health records will be logged out to the OOS transport agency using a
chain of custody form that will be completed at the staging facility by the Nurse Manager or his/her
designee.

•

A supply of all prescription medications ranging from four (4) to seven (7) days, depending upon the
State's agreement with the receiving State's facility.

_.

;..

P. MORTALITY REVIEWS
The Conh'actor shall coordinate with the State in the acquisition and submission of all relevant information
concerning the death of any inmate within ten (10) working days of the death, unless extenuating
circumstances require law enforcement investigation. This shall include preparation of mortality reviews and
other requirements mandated by NCCHC standards, state policies, and state and federal laws. Should a law
enforcement investigation be required, the DOC shall extend the timeframe for completion of the mortality
review, notifying Contractor of the revised mortality review due date. Failure to meet these mandates may
result in a penalty of up to $5,000.

Q. PERFORMANCE GUARANTEES
All medical services shall be delivered in compliance with standards set forth by the NCCHe. At such time as
these standards are updated, it is understood the standards promulgated under these performance guarantees
will be adjusted to ensure that Vermont DOC facilities remain in compliance with NCCHC standards, and
retain NCCHC accreditation.
Contractor is obliged to self-report all performance shortfalls that would trigger a penalty. Reports are due to
the DOC within five (5) business days after month-end close. Contractor may send a formal request to the
DOC requesting that a penalty be reconsidered or reduced due to extenuating circumstances. Should
- 49 -

Contractor choose to submit such a request, the DOC will render a decision within five (5) business days of
receipt of Contractor's request.
At the discretion of the Vermont DOC, performance guarantee penalties may be waived. Should the DOC
elect to waive a penalty, such waiver does not preclude the DOC from exercising its rights to enforce a penalty
in the future.
a. NCCHC Accreditation
Contractor is required to maintain NCCHC accreditation for every current and future facility in the State
system. If certification accreditation by the NCCHC is lost at any time, a $500 penalty per dayIper nonaccredited facility will be assessed against the vendor until the non-accredited facility(ies) receives either a
provisional accreditation or is fully accredited. If the NCCHC issues a provisional accreditation, the $500 per
day I per facility will be waived up to one hundred and eighty (180) days. The beginning and ending dates of
the penalty will be governed by any written communication from the NCCHe. Any date within any calendar
month will serve as the beginning and end dates and each inclusive month of non-accreditation will be
assessed the penalty.
It is understood that the Southern State Correctional Facility is newly-opened and has not been accredited to
date. The Parties shall develop a plan for the accreditation by NCCHC of this site no later than eight (8)
months following the commencement of the contract.

b. Access to Dental Services
Failure by the Contractor to meet dental hourly requirements or to adequately control the size of the waiting
list for dental services may result in a financial penalty up to $1,000 per occurrence. The size of the penalty
will be determined based on the extent to which the Contractor has failed to maintain adequate service
"" accessibility, and will be the subject of contract negotiation. The Contractor shall provide access to dental
'''''services according to the following standards:
•
•

urgent care: within 24 hours; and
routine care: within 28 calendar days of the sick call request.

Inmates with dental emergencies (i.e. facial fractures, uncontrolled bleeding, and infections not responsive to
antibiotics) shall receive immediate medical care, which may include emergency transportation to a hospital,
outpatient or inpatient facility.
c.

Operational and Financial Reports

Failure by the Contractor to prOVide required operational and financial reports within prescribed time periods
may result in a penalty of $1,000 per report per month for each month that any report is not received timely.
The DOC, at its sale discretion, may permit additional time for the submission of required reports under
extenuating circumstances beyond the Contractor's control.
d. Pharmaceutical Drug Availability
Failure to provide prescription drugs to inmates in accordance with contract standards will result.in a penalty.
For purposes of this performance guarantee, the following standards shall be applied:
- 50-

•
•
•

Ongoing treahnent plans - Within two (2) hours of the date and time the medication is scheduled to be
dispensed;
Newly ordered prescriptions - Within forty-eight (48) hours from Monday through Friday, and within
seventy-two (72) hours from Saturday through Sunday of a provider's non_"stat" order; and
"Stat" order - Contractor shall provide "stat" orders within one (1) hour of receipt of a "stat" order.

Failure to provide DOC inmates with medications based on the above time-standards will result in a penalty
of $1,000 per occurrence. The Contractor shall report each instance of non-compliance as a part of its monthly
CQI reporting.
. e. Staffing Standards and Coverage
It shall be the Contractor's final responsibility to fill all posts in accordance with the staffing standards and
coverage schedules per the Staffing Matrix (Attachment H), exclusive of posts filled by State employees.
Failure by the Contractor to fill these posts with permanent employees within thirty (30) days after a post has
become vacant (as scheduled in the Staffing Matrix), may result in a penalty as follows:
• Registered Nurses, Licensed Practical Nurses, Licensed Nursing Assistants, Nurses Aide, Dental Assistant,
and Medical Secretary/Administrative Assistant- $250 for each day or part thereof that the post is not
filled.
• Physicians, Physician Assistant, Nurse Practitioner, Dentist, Program Manager and Regional Director $500 for each day or part thereof that the post is not filled.

Contractor is expected to provide interim per diem staffing of health professionals trained to provide health
services within a cor"fectional setting for all health services-related positions vacant beyond one (1) week due
to illness, disability, disciplinary actions, and/ or staff departures. Failure by the Contractor to fill these posts
with per diem employees may result in a penalty of $500 for each day that the post is not filled.
,-.- Contractor must also ensure that no shift is left uncovered. Attachment K - Staffing Coverage Standards
,..

-'reflects the minimum staffing required by facility, by shift, by type of clinical staff for Contractor to avoid a
penalty under this provision. Contractor may, at its discretion and cost, fill clinical positions within higher
practice level professionals without penalty. Clinical staff cannot be asked to operate outside of their scope of
practice to cover a shift. Failure by the Contractor to cover a shift will result in a penalty of $1,000 for each
uncovered shift.
f.

Sick Call Timeliness

Contractor shall provide sick call services, in compliance with NCCHC standards, to allow the health care staff
to provide same-day response to urgent inmate requests for health care services. Contractor will be charged
$50 per each sick call request outstanding for more than forty-eight (48) hours of the requestduring a week day
(Monday through Friday) Contractor shall make a good faith effort to meet the forty-eight (48) hour standard
from Saturday to Sunday, but consistent with the NCCHC standards for sick call response times, Contractor
will be held to a maximum of seventy-two (72) hours from Saturday to Sunday before a penalty will be taken.
g. Implementation Plan
In the event that Contractor fails to be fully operational by February 1, 2005, Contractor may be charged up to
$25,000 per day until full operational status has been achieved. The size of the penalty shall be proportionate
to Contractor's shortfall in operational readiness. On February 1, 2005, the Vermont DOC Administration will
notify Contractor in writing of its assessment of operational status - fully operational or non-compliant.
- 51 -

Compliance shall be based upon completion of the key milestones in Attachment G, as determined by the
VDOC. The DOC shall detail all compliance shortfalls by facility and function. Contractor will develop
detailed corrective action plans for all non-compliant facilities and functions within five calendar days of DOC
operational assessment letter.
Once the DOC has notified Contractor in writing that full operational status has been achieved, this
performance guarantee will not longer be applied throughout the remainder of the contract period.
h. Hospital/Community Provider Clean Claims Payment
All payments to hospitals and other community providers should be made within thirty (30) days of the
Contractor's receipt of a clean claim. Failure to promptly reconcile and pay hospitalj community provider
claims shall be grounds for penalties or contract termination. All clean claims thirty (30) days or more in
arrears shall be reported to the DOC as a part of the Contractor's monthly quality improvement reporting, and
may be assessed twenty (20) percent of the gross claim amount.
i.

Access to Specialty Services

Under no circumstances shall Contractor limit or delay access to specialty services for inmates identified as
requiring this care. If the DOC believes that the Contractor is not providing specialty services in a timely
fashion, the DOCs Health Services Director and the Conti'actor's Medical Director shall review and resolve all
disputes. Should the resolution find in favor of the inmate's need for specialty services, the DOC Health
Services Director and Contractor's Medical Director shall also agree upon a target date when services will
commence. Failure by Contractor to provide access to these services on the target date may result in a penalty
of $1,000 per day for every day after the target date until services commence. Failure to reach a resolution may
result in a penalty of $5,000 per incident, and ultimately may be grounds for termination.

j.

Mortality Review Timeliness

The Contractor shall coordinate with the State in the acquisition and submission of all relevant information"
concerning the death of any inmate within ten (10) working days of the death, unless extenuating
circumstances require law enforcement investigation. This shall include preparation of mortality reviews and
other requirements mandated by NCCHC standards, state policies, and state and federal laws. Should a law
enforcement investigation be required, the DOC shall extend the timeframe for completion of the mortality
review, notifying Contractor of the revised mortality review due date. Should Contractor fail to acquire and
submit information before or on the due date, or meet NCCHC standards, state policies, state and federal laws
governing mortality reviews, a penalty of up to $5,000 per occurrence may be taken.

- 52-

ATTACHMENT B

CONTRACT FOR SERVICES
PAYMENT PROVISIONS

Contractor agrees to invoice the State for services no less frequently than monthly. The Contractor agrees to
render an invoice to the State by fifteen (15) days following the last day of the month in which the service was
provided. The State will not be liable for payments for any service invoiced after the 15-day limit.
Upon the Contractor's successful performance of the terms set forth in Attachment A, the State agrees to pay
the Contractor according to the procedures described below.
The Contractor will submit two monthly invoices: one for the base services and one for additional monthly
charges for mental health medications, Hepatitis B and Diphtheria/Tetanus inununizations and tuberculosis
testing services for DOC staff, as well as incremental charges for the assessment and observation of
incapacitated persons.
1) Base Payment
Contractor's base payment is a capitated Per Inmate Per Month (PIPM) amount multiplied by the total number
of DOC inmates. The following is a schedule of the at-risk pricing for the contract period. Under the
capitated, at-risk model, Contractor shall be paid on a per inmate per month basis for no fewer than 1,600
ADP, even if the ADP drops below 1,600.

2/1/05 -1/31/06
;;..

$ 451.03

$ 741,937

1,645

$ 8,903,244

il--------'--_
_------_
_--~---_I_------_I_--~--__Ii

·2/1/06 -1/31/07

$ 478,78

$ 787,590

1,645

$ 9,451,075

2/1/07 -1/31/08

$ 510.16

$ 839,206

1,645

$ 10,070,474

The Contractor shall submit an invoice the first day of the month for services provided in the previous month.
Resolution of any issues regarding the ADP used for a base month payment shall be addressed and reconciled
in the following month. The State shall reimburse the Conh·actor within thirty (30) days of receipt of the
Contractor's invoice. The State shall discuss all deductions and performance penalties with the Contractor in
advance of payment. If the State does not pay the invoice within thirty (30) days of receipt, it will pay the
Conh·actor an additional 1.5 percent per month of the invoiced amount for late charges.
a. Prepaymenl/Performance Guarantee
Contractor has proposed two options for reducing service delivery costs: (1) prepayment of base monthly fee
at the beginning of each month, and (2) the use of a Performance Guarantee in place of a traditional
performance bond. Should the DOC elect one or both options, the proposed reduction in cost is shown in the
following table:

- 53-

Prepayment

$

70,562

$ 72,679

$

74,859

Performance
Guarantee

$ 23,446

$ 24,889

$

26,520

2) Additional Monthly Charges
Additional monthly charges are invoiced separately from services included in the base payment. The
Contractor shall submit an invoice the tenth day of the month for services provided in the previous month.
The additional monthly charges for incidental adjustment services shall adhere to the following schedule by
service.
.

Incidental Services
Per Encounter

II
I

i
;-

.

Mental Health
Medications5(including
those mentioned inAtt
A, Section W, Subpart c)
Hepatitis B Vaccine 6
Diphtheriafretanus
Vaccine
TB Testing
Incapacitated Persons
Assessment and
Observation'

Year1

I>

(2005/2006)

x

$ 240,000.00

')

i\"UU' :-

$ 270,000.00

"

$ 300,000.00

I

$

69.00

$

75.21

$

81.98

$

1.00

$

1.09

$

1.19

$

10.00

$

10.90

$

11.88

$

27.30

$

28.66

$

30.09

I

I

The State shall reimburse the Contractor following a reconciliation for cost of services provided and any
applicable adjustments to the invoice. The reconciliation shall include:
•

Deductions for performance penalties - Contractor shall report any deficiencies or occurrences that might
result in a penalty provided for in this contract's performance guarantees. The State shall independently
evaluate Contractor's service delivery for any deficiencies or occurrences that might result in a penalty.

5 Amount is the maximum annual budgeted amount. Any amounts over this maximum will be directly paid
by VDOC. Components covered under Mental Health Medications to be reimbursed include: acquisition costs
as well as back-up pharmacy expenses, courier service and dispensing fees.
6 Contractor's price per Hepatitis B shot ($23.00 in Year 1) multiplied by three, the required number of shots to
achieve full immunization.
7 This .amount includes a $5,000 annual aggregate offsite cap. Any offsite savings under this $5,000 annual cap
will be refunded to VDOC. Any offsite expense in excess of the annual aggregate cap will be the financial
responsibility of VDOC.

- 54-

•

Any deficiencies in performance may result in payment reductions as delineated in Chapter Five, Section Q
- Performance Guarantees. The State shall discuss all proposed performance penalties with the Contractor
in advance of invoice payment.

•

Changes in VHAP Policy - PHS' price proposal incorporated projected VHAP program payment of certain
inpatient expenses currently covered under the program. In the event of a change in federal and! or state
policy and inmate participation in the VHAP program is substantially altered, the Parties will agree to
negotiate a contract amendment responding to the changing fiscal environment.

All adjustments will be fully documented and discussed with Contractor prior to the issuance of an adjusted
payment by the State.
3) Miscellaneous Provisions
It is understood and agreed that Conh'actor's proposal was based on utilization data furnished by DOC and
the current community standards of care applicable to providing health care services to the incarcerated
population. In the event, over the term of the agreement, there are any changes in the standards of care or in
the conditions-related representations by the DOC, Contractor shall be entitled to request an amendment.
Contractor's cost proposal is predicated upon the DOC providing mental health care services. Should the
DOC fail to provide these services, Contractor shall seek an amendment to the contract.
Change in Standard pf Care or Scope of Services: The price in this contract reflects the scope of services as
outlined herein, and the current community standard of care with regard to healtl1Care services. Should there
be any change in or modification of inmate distribution, standards of care (e.g., changes in HN! AIDS therapy,
Hepatitis B therapy, etc.), scope of services, or available workforce pool that results in material costs to the
Contractor, the costs related to such changes or modifications are not covered in this contract, and shall be
". negotiated with the State. If the parties are unable to reach a mutual agreement on these costs within thirty
. '(30) days from either party's request to negotiate, either party may terminate this contract by providing the
other party with ninety (90) days written notification thereof.
Force Majeure: Neither the State nor the Contractor shall be held responsible for any delay or failure in
performance (other than payment obligations) to the extent that such delay or failure in performance is caused
by fire, flood, hurricane, explosion, war, strike, labor action, terrorism, embargo, governmental regulation, riot,
civil or military authority, acts of God, acts or omissions of carriers or other similar causes beyond their
controL
Additionally, it is hereby agreed and understood that this contract has no minimum amount. The Contractors' services
will be required on an "as needed" basis.
4) Contractor shall submit all invoices to:
Vermont Department of Corrections
103 South Main Street
Waterbury, VT 05671-1001

- 55 -

ATTACHMENT C
CONTRACT FOR SERVICES
CUSTOMARY STATE CONTRACT PROVISIONS (Revised 12/01103)
1.

Entire Agreement. This contract represents the entire agreement between the parties on the
subject matter. All prior agreements, representations, statements, negotiations, and understandings
shall have no effect.

2.

Applicable Law. This contract will be governed by the laws ofthe State of Vermont.

3.

Appropriations. If this contract extends into more than one fiscal year of the state (July I to June
30), and if appropriations are insufficient to support this contract, the State may cancel at the end of
the fiscal year, or otherwise upon the expiration of existing appropriations authority.

4.

No Employee Benefits for Contractors. The Contractor understands that the State will not provide
any individual retirement benefits, group life insurance, group health and dental insurance, vacation and
sick leave, workers compensation or other benefits or services available to State employees, nor will the
State withhold any federal or state taxes except as required under applicable tax laws, whieh shall be
determined in advance of execution of the contract. TIle Contractor understands that all tax returns
required by the Internal Revenue Code and the State of Vermont, including but not limited to income,
withholding, sales and use, and rooms and meals, must be filed by the Contractor, and information as to
contract income will be provided by the State of Vermont to the Internal Revenue Service and the
Vermont Department of Taxes.

5.

Independence, Liability. The Contractor will act in an independent capacity and not as officers or
employees of the State. The Contractor shall indemnify, defend and hold harmless the State and its
officers and employees from liability and any claims, suits, judgments, and damages, whieh arise as a
result of the Contractor's acts and/or omissions in the performance of services under this contract. The
Contractor shall notify its insurance company and the State within 10 days of receiving any claim for
damages, notice of claims, pre-claims, or service ofjudgments or claims, for any act or omissions in the
performance of this contract. See Attachment L for independence liability hold harmless clause.

6.

Insurance. Before commencing work on this contract the Contractor must provide certificates of
insurance to show that the following minimum coverage are in effect. The Contractor must notifY the
State no more than 10 days after receiving cancellation notice of any required insurance policy. It is the
responsibility of the Contractor to maintain current certificates ofinsunince on file with the State through
the term of the contract. Failure to maiutain the required insurance shall constitute a material breach of
this contract.
Workers Compensation: With respect to all operations performed, the Contractor shall carry
workers compensation insurance in accordance with the laws of the State of Vermont.
General Liability and Property Damage: With respect to all operations performed under the
contract, the Contractor shall carry general liability insurance having all major divisions of coverage
including, but not limited to:
Premises - Operations
Independent Contractors' Protective
Products and Completed Operations
Personal Injury Liability
Contractual Liability

56

The policy shall be on an occurrence form and limits shall not be less than:
$1,000,000 Per Occurrence
$3,000,000 General Aggregate
$1,000,000 Products/Completed Operations Aggregate
$ 50,000 fire Legal Liability
Automotive Liability: The Contractor shall carry automotive liability insurance covering all
owned, non-owned and hired vehicles used in cOlmection with the contract. Limits of coverage shall
not be less than: $1,000,000 Combined single limit.
Professional Liability: Before commencing work on this contract and throughout the term of this
contract, fue Contractor shall procure and maintain professional liability insurance for any and all
services performed under this contract, with minimum coverage of$I,OOO,OOO per occurrence and
$3,000,000 general aggregate.
No warranty is made that the coverage and limits listed herein are adequate to cover and protect the
interests of the Contractor for the Contractor's operations. These are solely minimums that have been set
to protect the interests of the State.
7.

Reliance by the State on Representations: All payments by the State under this contract will be made
in reliance upon the accuracy of all prior representations by the Contractor, including but not limited to
bills, invoices, progress reports and other proofs of work.

8.

Records Available for Audit. The Contractor wiII maintain all books, documents, payroll, papers,
accounting records and other evidence pertaining to costs incurred under this agreement and make them
available at reasonable times during the period of the contract and for three years thereafter for
inspection by any authorized representatives of the State or Federal government. If any litigation, claim
or audit is started before the expiration of the three year period, the records shall be retained until all
litigation, claims or audit findings involving the records have been resolved. The State, by any
authorized representative, shall have the right at all reasonable times to inspect or otherwise evaluate the
work performed or being performed under this contract.

9.

Fair Emolovment Practices and Americans with Disabilities Act: Contractor agrees to comply with
the requirement of Title 21 V.S.A. Chapter 5, Subchapter 6, relating to fair employment practices, to the
full extent applicable. Contractor shall also ensure, to the full extent required by the Americans with
Disabilities Act of 1990, that qualified individuals with disabilities receive equitable access to the
services, programs, and activities provided by the Contractor under this contract. Contractor further
agrees to include this provision in all subcontracts.

10. Set Off: The State may set off any sums which the Contractor owes the State against any sums due the
Contractor under this contract; provided, however, that any set off of amounts due the State of Vermont
as taxes shall be in accordance with the procedures more specifically provided hereinafter.
I 1. Taxes Due to the State.
a. Contractor understands and acknowledges responsibility, if applicable, for compliance with State tax
laws, including income tax withholding for employees performing services within the State, payment of
use tax on property used within the State, corporate and/or personal income tax on income earned within
the State.

57

b. Contractor certifies under the pains and penalties of perjury that, as ofthe date the contract is signed,
the Contractor is in good standing with respect to, or in full compliance with, a plan to pay any and all
taxes due the State of Vermont.
c. Contractor understands that final payment under this contract may be withheld ifthe Commissioner of
Taxes determines that the Contractor is not in good standing with respect to or in full compliance with a
plan to pay any and all taxes due to the State of Vermont.
d. Contractor also understands the State may set off taxes (and related penalties, interest and fees) due to
the State of Vermont, but only if the Contractor has failed to make an appeal within the time allowed by
law, or an appeal has been taken and finally determined and the Contractor has no further legal resource
to contest the amounts due.
12. Child Support. (Applicable if Contractor is a natural person, not a corporation or partnership.)
Contractor states that, as of the date the contract is signed, he/she:
a. is not under any obligation to pay child support; or
b. is under such an obligation and is in good standing with respect to that obligation; or
c. has agreed to a payment plan with the Vermont Office of Child Support Services and is in full
compliance with that plan.
Contractor makes this statement with regard to support owed to any and all children residing in Vermont.
In addition, if the Contractor is a resident of Vermont, Contractor makes this statement with regard to
support owed to any and all children residing in any other state or territory of the United States.
13. Subcontractors. The Contractor shall not assign or subcontract the performance of this agreement or
any portion thereof to any other contractor without the prior written approval of the State. Contractor
also agrees to include in all subcontract agreements a tax certification in accordance with paragraph II
above.

14. No Gifts or Gratuities. Contractor shall not give title or possession of any thing of substantial value
(including property, currency, travel and/or education programs) to any officer or employee of the State
during the term of this contract.
15. Copies. All written reports prepared under this contract will be printed using both sides of the paper.
16. Access to Information. The Contractor agrees to comply with the requirements of AHS Rule No. 96-23
concerning access to information. The Contractor shall require all of its employees performing services
under this contract to sign the AHS affirmation of understanding or an equivalent statement.
17. Suspension and Debarment. Non-federal entities are prohibited by Executive Orders 12549 and 12689
from contracting with or making sub-awards under covered transactions to parties that are suspended or
debarred or whose principals are suspended or debarred. Covered transactions include procurement
contracts for goods or services equal to or in excess of $100,000 and all non-procurement transactions
(sub-awards to sub-recipients). By signing this contract, current Contractor certifies as applicable, that
the contracting organization and its principals are not suspended or debarred by GSA from federal
procurement and non-procurement programs.
18. Health Illsurance Portability & Accountability Act (HIPAA). The confidentiality of any health care
information acquired by or provided to the independent contractor shall be maintained in compliance
with any applicable state or federal laws or regulations.

58

19. Abuse Registry. The Contractor agrees not to employ any individual to care for elderly or disabled
adults if there has been a substantiation of abuse, neglect, or exploitation against that individual. The
Contractor will check the Adult Abuse Registry in the Department of Aging and Disabilities for the
names of all such current or prospective employees.
20. Voter Registration. When designated by the Secretary of State, the Contractor agrees to become a voter
registration agency as defined by 17 V.S.A. §2103 (41), and to comply with the requirements of State
and Federal law pertaining to such agencies.

59

ATTACHMENT D
CONTRACT FOR SERVICES
MODIFICATION OF MAXIMUM INSURANCE REQUIREMENTS
The requirements contained in Attachment C, Section 6 are hereby modified:

No Modifications
Type of Insurance Coverage:

Modifications:

Reasons for Modifications:

Approval:

Assistant Attorney General:

_

~

Date:

60

ATTACHMENT E
CONTRACT FOR SERVICES
BUSINESS ASSOCIATE AGREEMENT (REVISED 12/01103)
THIS BUSINESS ASSOCIATE AGREEMENT ("AGREEMENT") IS ENTERED INTO BY AND
BETWEEN THE STATE OF VERMONT, AGENCY OF IillMAN SERVICES, OPERATING BY AND
THROUGH ITS DEPARTMENT OF CORRECTIONS ("COVERED ENTITIES") AND PRISON
HEALTH SERVICES, INC ("BUSINESS ASSOCIATE"), AS OF 02/01/05 ("EFFECTIVE DATE").
Preliminary Statement. Covered Entity and Business Associate have entered into the Contract to which
this Business Associate Agreement is an attachment pursuant to which Business Associate provides to
Covered Entity certain services ("Services") which may require the use and/or disclosure of health
infomlation. For the avoidance of any doubt, "Services" includes all work perfoill1ed by the Business
Associate for or on behalf of Covered Entity. This Agreement supplements and is made a part of the
Contract.
The parties enter into this Agreement to comply with standards promulgated under the Health msurance
Portability and Accountability Act of 1996 ("HIPAA"), including the Standards for the Privacy of
mdividually Identifiable Health mfoill1ation, at 45 CFR Parts 160 and 164 ("Privacy Rule"), and the Security
Standards, at 45 CFR Parts 160 and 164 ("Security Rule").
Agreement. m consideration of the foregoing, and in consideration of the desire of Covered Entity to
continue receiving Services, and of Business Associate to continue providing Services, the parties agree as
follows:

(:'

1.

Definitions. All capitalized teill1S in this Agreement have the meanings identified in this Agreement,
45 CFR Part 160, or 45 CFR Part 164. The teill1 "Individual" includes a person who qualifies as a
personal representative in accordance with 45 CFR l64.502(g). All references to PHI mean Protected
Health Infoill1ation. All references to Electronic PHI mean Electronic Protected Health mfoill1ation.

2.

Permitted and Reqnired Uses/Disclosures of PHI.
2.1

Except as limited in this Agreement, Business Associate may use or disclose PHI to perfoill1 the
Services, provided that any use or disclosure would not violate the minimum necessary policies
and procedures of Covered Entity. Business Associate shall not use or disclose PHI in any
manner that would constitute a violation of the Privacy Rule if used or disclosed by Covered
Entity in that manner. Business Associate may not use or disclose PHI other than as peill1itted or
required by this Agreement or as Required by Law.

2.2 Business Associate may make PHI available to its employees who need access to provide Services
(provided that Business Associate makes such employees aware of the use and disclosure
restrictions in this Agreement and binds them to comply with such restrictions). Business
Associate may only disclose PHI for the purposes authorized by this Agreement: (a) to its agents
(including subcontractors), in accordance with Sections 6 and 14; or (b) as otherwise pem1itted by
Section 3.
3.

Business Activities. Business Associate may use PHI received in its capacity as a "Business
Associate" to Covered Entity, if necessary, for its proper management and administration or to carry out
its legal responsibilities. In addition, Business Associate may disclose PHI received in its capacity as
"Business Associate" to Covered Entity, for its proper management and administration or to carry out
its legal responsibilities, if a disclosure is Required by Law, or: (a) Business Associate obtains
reasonable written assurances (via a written contract) from the person to whom the infom1ation is to be
disclosed that the PHI shall remain confidential and be used or further disclosed only as Required by
Law or for the purpose for which it was disclosed to the person; and (b) the person promptly notifIes
61

Business Associate (who in tum will promptly notify Covered Entity) in writing of any instances of
which it is aware in which the confidentiality of the PHI has been breached. All uses and disclosures of
PHI for the purposes identified above must be of the minimum ,amount of PHI necessary to accomplish
such purposes.
4.

Safeguards. Business Associate shall implement and use appropriate safeguards to prevent the use or
disclosure of PHI, other than as provided for by this Agreement. Business Associate shall identify in
writing, upon request from Covered Entity, all of the safeguards that it uses to prevent impermissible
uses or disclosures of PHI.

5.

Reporting. Business Associate shall report in writing to Covered Entity any use or disclosure of PHI in
violation of this Agreement by Business Associate or its agents (including subcontractors). Business
Associate shall provide such written report promptly after it becomes aware of any such use or
disclosure. Business Associate shall provide Covered Entity with the information necessary for
Covered Entity to investigate any such use or disclosure. Business Associate may use PHI to report
violations oflaw to appropriate federal and state authorities, consistent with 45 CFR 164.502(j)(l).

6.

Agreements by Third Parties. Business Associate shall ensure that any agent, including a
subcontractor, to whom it provides PHI received from, or created or received by Business Associate on
behalf of, Covered Entity, agrees in a written contract to the same restrictions and conditions that apply
through this Agreement to Business Associate, with respect to such PHI. By way of example, the
written contract must include those restrictions and conditions set forth in Section 12. Business
Associate must enter into the written contract before any use or disclosure of PHI by such agent, and
such written contract must identify Covered Entity as a direct and intended third party beneficiary, with
the right to enforce any breach of the contract concerning the use or disclosure of PHI. Business
Associate shall provide a copy of the written contract to Covered Entity upon request. Business
Associate may not make any disclosure of PHI to any agent without the prior written consent of
Covered Entity.

7.

Access to PHI. Business Associate shall provide access to PHI in a Designated Record Set to Covered
Entity or, as directed by Covered Entity, to an Individual, to meet the requirements under 45 CFR
164.524. Business Associate shall provide such access in the time and manner reasonably designated
by Covered Entity. Business Associate shall promptly forward to Covered Entity for handling any
request for access to PHI that Business Associate directly receives from an Individual.

8.

Amendment of PID. Business Associate shall make any amendments to PHI in a Designated Record
Set that Covered Entity directs or agrees to pursuant to 45 CFR 164.526, whether at the request of
Covered Entity or an Individual. Business Associate shall make such amendments in the time and
manner reasonably designated by Covered Entity. Business Associate shall promptly forward to
Covered Entity for handling any request for amendment to PHI that Business Associate directly
receives from an Individual.

9.

Acconnting of Disclosures. Business Associate shall document disclosures of PHI and all information
related to such disclosures as would be required for Covered Entity to respond to a request by an
Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528. Business
Associate shall provide such information to Covered Entity, or as directed by Covered Entity, to an
Individual, to permit Covered Entity to respond to an accounting request. Business Associate shall
provide such information in the time and manner reasonably designated by Covered Entity. Business
Associate shall promptly forward to Covered Entity for handling any accounting request that Business
Associate directly receives from an IndividuaL

62

10. Books and Records. Subject to the attorney-client and other applicable legal privileges, Business
Associate shall make its internal practices, books, and records (including policies and procedures and
PHI) relating to the use and disclosure of PHI received from, or created or received by Business
Associate on behalf of, Covered Entity available to the Secretary in the timc and manner designated by
the Secretary. Business Associate shall make the same information available to Covered Entity
(without regard to the attorney-client or other applicable legal privileges), upon request, in the time and
manner reasonably designated by Covered Entity, so that Covered Entity may determine whether
Business Associate is in compliance with this Agreement.
11. Termination.
11.1

This Agreement commences on the Effective Date and shall remain in effect until terminated by
Covered Entity, or until all of the PHI provided by Covered Entity to Business Associate, or
created or received by Business Associate on behalf of Covered Entity, is destroyed or returned
to Covered Entity, subject to Section 15.12.

11.2

If Business Associate breaches any material term of this Agreement, Covered Entity may either:
(a) provide an opportunity for Business Associate to cure the breach, and Covered Entity may
terminate each Services Agreement, without liability or penalty, if Business Associate does not
cure the breach within the time specified by Covered Entity; or (b) immediately terminate each
Services Agreement, without liability or penalty, if Covered Entity believes that cure is not
reasonably possible; or (c) if neither termination nor cure are feasible, Covered Entity shall
report the breach to the Seeretary. Covered Entity has the right to seek to cure any breach by
Business Associate and this right, regardless of whether Covered Entity cures such breach, does
FlOt lessen any right or remedy available to Covered Entity at law, in equity, or under this
Agreement or any Services Agreement, nor does it lessen Business Associate's responsibility for
such breach or its duty to cure such breach.

12. ReturnlDestruction of pm.
12.1

Business Associate shall, in connection with the expiration or termination of a Services
Agreement, return or destroy all PHI received from Covered Entity, or created or received by
Business Associate on behalf of Covered Entity, and pertaining to that Services Agreement, that
Business Associate still maintains in any form or medium (including electronic), within thirty
(30) days after such expiration or termination. Business Associate shall not retain any copies of
such PHI. Business Associate shall certify for Covered Entity, in writing, when all PHI has been
returned or destroyed, and that Business Associate does not continue to maintain any PHI, with
such certification to be provided during such thirty (30) day period.

12.2

Business Associate shall provide to Covered Entity notification of any conditions that Business
Associate believes make the return or destruction of PHI infeasible. If Covered Entity agrees
that return or destruction is infeasible, Business Associate shall extend the protections of this
Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that
make the return or destruction infeasible, for so long as Business Associate maintains such PHI.

13. Notice/Training. Business Associate understands that: (a) there may be civil or criminal penalties for
misuse or misappropriation of PHI; and (b) violations of this Agreement may result in notification by
Covered Entity to law enforcement officials and regulatory, accreditation, and licensure organizations.
If requested by Covered Entity, Business Associate shall participate in information security awareness
training regarding the use, confidentiality, and security of PHI.

63

14. Security Rule Obligations. The following provislOns of this Section 14 apply to the extent that
Business Associate creates. receives, maintains or transmits Electronic PHI on behalf of Covered Entity.
14.1

Business Associate shall implement and use administrative, physical, and technical safeguards
that reasonably and appropriately protect the Confidentiality, Integrity and Availability of the
Electronic PHI that it creates, receives, maintains or transmits on behalf of Covered Entity.
Business Associate shall identify in writing, upon request from Covered Entity, all of the
safeguards that it uses to protect such Electronic PHI.

14.2

Business Associate shall ensure that any agent, including a subcontractor, to whom it provides
Electronic PHI agrees in a written contract to implement and use administrative, physical, and
technical safeguards that reasonably and appropriately protect the Confidentiality, Integrity and
Availability of the Electronic PHI. Business Associate must enter into the written contract
before any use or disclosure of Electronic PHI by such agent, and such written contract must
identify Covered Entity as a direct and intended third party beneficiary, with the right to enforce
any breach of the contract concerning the use or disclosure of Electronic PHI. Business
Associate shall provide a copy of the written contract to Covered Entity upon request. Business
Associate may not make any disclosure of Electronic PHI to any agent without the prior written
consent of Covered Entity.

14.3

Business Associate shall report in writing to Covered Entity any Security Incident pertaining to
such Electronic PHI (whether involving Business Associate or an agent, including a
subcontractor). Business Associate shall provide such written report promptly after-it becomes
aware of any such Security Incident. Business Associate shall provide Covered Entity with the
inft?rmation necessary for Covered Entity to investigate any such Security Incident.

14.4

Business Associate shall comply with any reasonable policies and procedures Covered Entity
implements to obtain compliance under the Security Rule.

15. Miscellaneous.
15.1

Notwithstanding anything to the contrary in any Services Agreement, in no event shall any
provision limiting Business Associate's liability to Covered Entity, including, but not limited to,
provisions creating a cap on damages, excluding certain types of damages, limiting available
remedies, or shortening a statute of limitations, present in any Services Agreement, apply with
respect to any breach by Business Associate of any term of this Agreement.

15.2

In the event of any conflict or inconsistency between the terms of this Agreement and the terms
of any Services Agreement, the terms ofthis Agreement shall govern, with respect to its subject
matter. Otherwise, the terms of each Services Agreement continue in effect.

15.3

Any reference to "promptly" in this Agreement shall mean no more than seven (7) business days
after the circumstance or event at issue has transpired. A reference in this Agreement to a
section in the Privacy Rule or Security Rule means the section as in effect or as amended or
renumbered.

15.4

Business Associate shall mitigate, to the extent practicable, any harmful effect that is known to it
of a use or disclosure of PHI in violation of any provision of this Agreement.

64

15.5

Business Associate shall cooperate with Covered Entity to amend this Agreement from time to
time as is necessary for Covered Entity to comply with the Privacy Rule, the Security Rule, or
any other standards promulgated under HIPAA.

15.6

Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply with the
Privacy Rule, Security Rule, or any other standards promulgated under HIPAA.

15.7

In addition to applicable state law, the parties shall rely on applicable federallaw (e.g., HIPAA,
the Privacy Rule and Security Rule) in construing the meaning and effect of this Agreement.

15.8

This Agreement may be amended or modified, and any right under this Agreement may be
waived, only by a writing signed by an authorized representative of each party.

15.9

Nothing express or implied in this Agreement is intended to confer, upon any person other than
the parties hereto, any rights, remedies, obligations or liabilities whatsoever. Notwithstanding
the foregoing, the Covered Entity in this Agreement is the Agency of Human Services, operating
by and through its Department of Corrections. Covered Entity and Business Associate agree that
the term "Covered Entity", as used in this Agreement, also means any other Department,
Division or Office of the Agency of Human Services, to the extent that such other Department,
Division, or Office has a relationship with Business Associate that would require, pursuant to the
Privacy or Security Rules, entry into an agreement of this type.

15.10 As'between Business Associate and Covered Entity, Covered Entity owns all PHI provided by
Covered Entity to Business Associate, or created or received by Business Associate on behalf of
Covered Entity.
15.11 Business Associate shall abide by the terms and conditions of this Agreement with respect to all
PHI it receives from Covered Entity, or creates or receives on behalf of Covered Entity, even if
some of that information relates to specific Services for which Business Associate may not be a
"Business Associate" of Covered Entity under the Privacy Rule.
15.12 The provisions of this Agreement that by their terms encompass continuing rights or
responsibilities shall survive the expiration or termination of this Agreement. For example: (a)
the provisions of this Agreement shall continue to apply if Covered Entity determines that it
would be infeasible for Business Associate to return or destroy PHI, as provided in Section 12.2;
and (b) the obligation of Business Associate to provide an accounting of disclosures, as set forth
in Section 9, survives the expiration or termination of this Agreement, with respect to accounting
requests (if any) made after such expiration or termination.
15.13 This Agreement constitutes the entire agreement of the parties with respect to its subject matter,
superseding all prior oral and written agreements between the parties in such respect.

65

ATTACHlVlENT F
CONTRACT FOR SERVICES
Agency of Human Services Rnle # 96·23
Final Adopted Rnle for
Access to Information
Definition.

"Agency" means the Agency of Human Services or any of the offices, departments or
programs that comprise the Agency.
"AHS" means the Vermont Agency of Human Services.
"Client" means an individual or family who is voluntarily served by a department, office,
program, Contractor or grantee of the Agency of Human Services.
"Contractor" means an individual or entity with whom the Agency or any of its
departments, offices, or programs has a contract to provide personal services.
"Employee" means any person who works in a full-time, part-time, temporary or
contractual position for the Agency or any of its departments, offices, or programs.
1.6
"Grantee" means an individual or entity with whom the Agency or any part thereof
has a grant to'provide personal services.
1.7
"Program" means a set of services, (such as determining and processing ANFC benefits,
verifying and setting up delivery for WIC foods) for which the Agency bears fiscal responsibility.
1.8
"Administrative Obligations" means activities pursuant to federal or state laws or
regulations (such as verification of eligibility, verification of service delivery, detention of fraud, monitoring
of quality assurance, audit of expenditure reports) which provide for accountability in the use of public
funds.
Basic Principles
Presumption of Confidentiality
All information specific to, and identifying of, individuals and families is presumed to be
confidential and subject to these standards. Employees shall not disclose the information unless a specific
exception to the presumption applies or the disclosure is authorized by .the client, a court or as otherwise
authorized by law or rule.
Existing Statutes
These rules are not intended to expand or diminish current provisions in law relating to
disclosure of confidential information.

Information Collection
Employees shall collect and record only that information needed to fulfill the goal of

66

serving the client and meeting administrative or legal obligations.
Informing Clients
At the initial meeting with each client, or within two weeks, employees shall review and
offer to provide the rules for access to information to the client.

Permissible Disclosures
Client consent
No information about a client shall be released without prior consent from the client,
unless directly connected with the administration of a program or necessary for compliance with federal or
state laws or regulations.
Sharing "Non-identifiable" Information
Information that does not identify adient may be used for statistical research, forecasting
program needs, or other such purposes.
Public Information
Information defined as public by 1 VSA & 317 or other applicable statute is available to the public.
TheprQcedures in the public records statute shall be followed before public information is released.
Information Sharing for Administrative Purposes
Employees may share information which is necessary to satisfY the Agency's administrative
obligations. Departments will develop written agreements limiting the kinds of information to be
shared when programs are jointly administered by different Departments. No information shall be
released to a person or entity that is out of state, unless directly connected with the administration of
a program or necessary for compliance with federal or state laws or regl.llations.
Disclosure Without Consent in Limited Circumstances
Employees must release sufficient information to comply with mandatory reporting
requirements for cases involving the abuse, neglect, or exploitation of children and persons who are elderly
or who have disabilities. Information may be released without consent when Vermont law creates a duty to
warn identified individuals of potential harm to their person or property, in response to court orders, or to
investigate or report criminal activity as required by federal or state law or regulation. Only information
relevant to the situation shall be disclosed. The employee shall document the date, purpose and content of
the report, the name, address and affiliation of the person to whom the information was released, and shall
notify the client that the information was disclosed.

AHS Rule 96-23
Procedures Related to Consent
Obtaining Informed Consent
Prior to releasing confidential information the Agency shall obtain the client's informed
67

consent. This includes providing information about consent in a language and format understandable to the
client. Reasonable accommodations shall be made for special needs based on the individual or family's
education, culture, or disability. Employees shall inform clients that granting consent is not a pre-requisite
for receiving services, and shall explain that they may apply for services separately.
Consent of Minors to Release of Information
Employees shall obtain the consent of a minor client to release information concerning
treatment for which parental consent is not required.

Format for Consent to Share Information
Consent for the sharing or release of information shall ordinarily be in writing. If an
emergency situation requires granting of verbal consent, written consent shall be obtained at the next office
visit or within thirty days, whichever comes sooner. Required information will include:
1. Names of the people about whom information may be shared.
2. A checklist of the kinds of information to be shared.
3. A checklist of the departments within the Agency to receive the information.
4. A statement or date covering expiration of consent.
5. A statement about procedures for revoking consent.
6. Signature of individuals covered by the consent, or their parents or guardians.
7. Sib'Ilature ofthe individual explaining the consent process with their position and job
title.
8. A space to provide individualized instructions.
A copy of the consent form shall be provided to all signatories.
Client Access to Records
Unless prohibited by federal or state law or regulation, clients shall be permitted to view
and obtain copies of their records. Each department within the Agency shall have written procedures which
permit clients to verify personal information they have provided for accuracy and completeness and for
placing amendments to the information in their files. Employees shall take reasonable steps to present
records in a form accessible to the client; inchlding but not limited to large type format or verbal review. A
fee not to exceed the actual cost of copying may be charged for records exceeding 10 pages. This fee shall
be waived if it would prohibit access.

AHS Rule 96-23
Procedures to Protect Confidentiality
Staff Training
All AHS employees and all AHS volunteers and interns, shall be instructed in these rules.
AHS shall train their Contractors and grantees who shall, in turn, provide the same instruction for their
employees, interns, and volunteers:
Response to Requests for Information
An employee shall not respond to requests from outside the Agency for information

68

about clients even to acknowledge that the person is a client, unless authorized. If a client has consented to
or requests that information be released, the employee shall comply with the request.
Designated Individual
Each agency or department shall appoint one or more trained staff members to be
responsible for responding to all requests for client information when there is no written consent to release,
and no statutory or administrative authority permitting release of the requested information. These
individuals shall be specially trained in maintaining confidentiality. A list of the designated individuals for
each department and office shall be maintained in the Attorney General's Office, Human Services Division.

Affirmation of Understanding
Employees shall sign an affirmation that they will comply with these rules. This
affirmation shall be part of their personnel files. Supervisors shall review this affirmation during annual
evaluations. Violation of these rules shall result in disciplinary action.
Written Agreements with Grantees or Contractors
The following assurance, or one similar to it, will be included in all AHS grants/contracts
signed after these rules have been approved:
[Grantee/Contractor] agrees to comply with the requirements of AHS Rule No. 96-23
concerning aCCess to information. The Contractor shall require all of its employees to sign the AHS
Affirmation of Understanding or an equivalent statement.
Client Referrals
When referring a client to another ageney for services, if the referral does not meet the
criteria for permissible disclosures under Section 3.4, the initial agency shall obtain the consent of the client
for the referral and alert the receiving agency that confidential client information accompanies the referral.

Documentation of Disclosure
Requests for disclosures of client information shall be maintained in the client's file if the
request does not meet the definition ofa permissible disclosure under Section 3.4. Employees shall
document in writing any information actually disclosed, along with the name of the person/agency to whom
it was disclosed and the date of the disclosure. When permissible disclosures m;e made under Section 3.4,
documentation may be limited to the name of the department/agency/program to whom the disclosure was
made.
Information Systems
Computerized Information
When developing a computerized data system, the Agency shall:
I. Develop security procedures consistent with the rule;
2. Instruct staff in the security procedures;
3. Inform clients if a computerized system is being used;

69

4. Establish written agreements with participating agencies outlining procedures for
sharing and protecting infonnation.
5. Develop security procedures in relation to the transmission ofinfonnation.
Security Procedures
The Agency shall develop a protocol which is consistent with the requirements of this
rule to safeguard confidential client infonnation. Contractors and grantees shall also develop a protocol or
shall adopt the protocol of the Agency. The protocol shall be designed to safegnard written infonnation, data
in computer systems, and verbal exchange of information. The protocol shall prohibit unauthorized access to
records and include an appropriate disciplinary process for violations of the security rules.
Procedures
Written procedures for implementing these rules shall be used as the basis for employee
Instruction and shall be available for review in the Agency Central Office.

70

AGENCY OF HUMAN SERVICES
103 South Maiu Street
Waterbury, Vermout 05676

AFFIRMATION OF UNDERSTANDING STATEMENT

As a Contractor for the State of Vermont, I affirm that I have read the Agency of Hnman Services
(AHS) Rnle No. 96-23 concerning Access to Information, and that I agree to comply with the
requirements of AHS Rule No. 96-23.

I shall require all of my employees performing services uuder this coutract, to sign an affirmation of
understanding statement. Employee statements need not be sent to the State. However, they shall
remain in Contraetor's personnel records.

The State ean request copies of sueh documents if

necessary.

Prison Health Services, Inc,

Name of Company (print or type)

Date

Authorized Signature

Title

71

Attachment G
PHS Implementation Plan
--- ._-

10

-

Task N~",p

<

1 Contract Awarded"
2 Establish management meeting schedule and implementation
agenda
3 Review implementation time frame and confirm with PHS team
and DOC
4 Inform PHS subcontractors of contract award
5 Establish Pharmacy Services
6 Arrange for Back-up Pharmacy Services
7 Contact local health department and other community resources
8 Obtain current employee list and provide to PHS human resource
department
9 Begin and complete facility assessment tours - all sites to include
inventory of medical supplies
10 Inform CMS personnel of contract award
11 Finalize PHS and operational teams to include on site Management
Team -.
12 Facility tours status report to client
13 Review employee retention potential with PHS resources unit and
DOC
1
Ii 14 Negotiate and finalize facility staffing and service matrix
i 15 Interview and make offers to current employees
16 Interview and make offers to new employees
17 Develop post orders and job responsibilities to each shift to include
clinical aspects and submit to client
18 Obtain security clearance for PHS staff from client
19 Submit names of management team to client for approval
20 Develop staff meeting schedule and provide copy to client
21 Regional Director start date
22 Medical Director/Physicians start date (if new staff)
23 Program Managers start date
124 RN/LPN start date (if new staff)
.25 Administrative assistants start date (if new staff)
26 New staff orientation and training
27 Pharmacy lnservice for Staff
28 Orient all current employees to PHS policies to include approved
protocols, PHS utilization review
Establish
site personnel files
29
i 30 Establish payroll system - installation of Chronos clock

Start
12/15/04
12/15/04

12/15/04
12/17/04

12/15/04

1/31/05

12/15/04
12/6/04
12/15/04
12/15/04

12/31/04
12/24/04
1/10/05
12/20/04

11/15/04

11/22/04

11/29/04

12/17/04

11/29/04
12/6/04

12/17/04
1/19/05

12/22/04
11/29/04

12/22/04
12/22/04

12/6/04
12/15/04
12/15/04
12/15/04

12/22/04 I
12/22/04
12/31/04 \1
1/12/05 II

12/15/04
12/6/04
1/4/05
1/3/05
1/17/05
1/17/05
1/17/05
1/24/05
1/17/05
1/17/05
1/3/05

1/17/05
1/3/05
1/17/05
1/3/05
1/17/05
1/17/05
1/17/05
1/24/05
1/31/05
1/31/05
1/24/05

1/4/05
1/17/05

1/24/05
1/31/05

l:OIlcl

I

Implementation dates contained in this Attachment may be adjusted, with DOC approval, should
the contract award date be delayed beyond December 15, 2004.

8

72

"""

-"

-

-

.

"

"

Task Name
31 Develop emergency telephone numbers and contact information
and provide to client (for both implementation and operational
teams)
32 Orient staff to PHS Information System requirements as needed
33 Develop in-service tmining annual schedule
i 34 Complete review of all client's current policies, procedures,
manuals and forms
i
35 Develop new policies and procedures, manuals and forms as
needed, review with client and obtain approval
,36 Develop work schedules and assignments
, 37 Provide proposed service schedule for client for approval
38 Develop on-call schedules as required and provide to client
39 Review and develop chronic care clinic schedules and submit to
client for informational purposes
Obtain
insurance certificates and coordinate insurance
40
requirements with corporate counsel and provide copies to client
41 Order all medical supplies
42 Order all office supplies to include forms relevant to providing
services specific to client
43 Establish petty cash fund
,44 Coordinate the transition of Health Service program from current
provider to ensure continuity
45 Coordinate fiscal responsibility with current provider'
46 Meet with Mental Health Provider
47 Assist in determining the requirements necessary for interface with
facility MIS system
48 Coordinate, receive and install new computers
49 Install phones, fax machines, computer lines (assuming DOC
network integration" If not achievable, CMS land lines will be
maintained),
50 Facilitate communication access (telephones, pagers)
51 Transfer Patient Information via medication administration records
for DOC inmates as of1/15/05
52 Transfer Patient Information daily via medication administration
records for DOC inmates with intakes after 1/15/05
53 Test MIS system for reporting capabilities to meet contract
requirements
ID

End

Start
12/15/04

1/17/05

1/24/05
1/4/05
12/6/04

1/31/05
1/31/05
1/3/05

12/22/04

1/17/04

12/20/04
12/6/04
12/6/04
12/15/04

12/31/04
12/31/04
12/31/04
12/31/04

12/15/04

12/31/04

1/10/05
1/10/05

1/21/05
1/24/05

1/17/05
12/15/04

1/31/05
1/31/05

12/15/04
1/17/05
12/15/04

2/14/05
1/21/05
1/14/05

12/15/04
12/15/04

1/21/05 ,
1/21/05

1/4/05
1/15/05

1/17/05
1/21/05

1/15/05

1/31/05

1/14/05

1/31/05

i

I
,

Process requires reconciliation between the estimated supplies and equipment to be purchased by
the Contractor from the incumbent and supplies and equipment left on-site as of February 1, 2005,
Contractor shall complete reconciliation and compensate the incumbent no later than February 14,
2005.
9

73

'('<'
I

'

Attachment H

Staffing Matrix
A. CORRECTIONAL FACILITIES SUMMARY - HOURS PER WEEK PElt POSITION
."

"

Physician Assistant
Nurse Practitioner
Registered Nurse
LPN
Nurses Aide
Dentist
Dental Assistant
Dental Hygienist
Medical Secretary/
Administrative Assistant
Other
Program Manager
IVermont Regional Director

2
4
0
40
0
0
4
4
0
0

10
0
20
152
136
112
16
16
0
16010

6
0
8
168
88
0
4
4
0
0

8
8
0
40
152
0
12
12
0
0

16
16
0
112
152
0
16
16
0
0

6
12
0
56
136
0
8
8
0
0

16
12
0
112
152
0
16
16
0
0

8
0
12
40
168
0
4
4
0
0

20
0
24
488
224
0
16
16
0
0

0
14
0

0
40
40

0
13.3

0
20
0

0
40
0

0
13.3
0

0
40
0

0
20
0

0
40
0

0

Contractor will staff a total of 160 hours per week for medical secretary/administrative assistant positions. TI1e location of these positions has yet
to be determined. Upon completion of facility site visits performed during implementation, Contractor will assign 120 hours per week of medical
secretary/administrative assistant time to other DOC facilities.
I

10

-74 -

B. INDIVIDUAL FACILITIES
1)

FTE
Medical Director
Dentist
Dental Assistant
Ph sielan Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
ILicensed Nursing Ass't

,
I
I

2

2
4
4
4
14

4
4
4
6

8

a
I

8

I

8

I

I

8

8

I

8

40

a
a
TOTAL

68

0.05
0.10
0.10
0.10
0.35
0.00
1.00
0.00
0.00
1.70

t:'

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

0

a
a
TOTAL HOURSjFTE-EVENING

0

a
a
a

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
TOTAL HOURSjFTE-NIGHT
TOTAL HOURS/FTE PER WEEK
*TBS = To be scheduled

- 75 -

0

68

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.70

:1''':;

2) Chittenden

.

-I"U::>IIIUN

.

.

Vermont Regional Director
Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

.

.
8
2
4
4
4
8
8
8
8

8
2
4
4
4
8
8
8
8

8
2
4
4
4
8
8
8
8

DA Y .:>M'I"
8
2
4
4
4
8
8
8
8

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
Registered Nurse
,Licensed Practical Nurse
Licensed Nursing Ass't

8
8
8

8
8
8

8
8
8

8
8
8

8
8
8

8
8
8

.

-

FTE

40
10
16
16
20
40
160
40
56
0
398

1.00
0.25
0.40
0.40
0.50
1.00
4.00
1.00
1.40
0.00
9.95

56
40
56
152

1.40
1.00
1.40
3.80

56
40
56
152

1.40
1.00
1.40
3.80
17.55

-

,

8
2

4
8
8
8
8

120
8

8

TOTAL HOURS/ FTE-DA Y
.

HRSI
WK

':>1"1/r-,

8
8
8

8
8
8
8
8
8
8
TOTAL HOURS/ ETE-EVENING

NIGHT <:>nll"'
8
8
8
8
8
8
8
8
8
8
TOTAL HOURS/ ETE-NIGHT
TOTAL HOURS/ITE PER WEEK

*TBS ::: To be scheduled

- 76·

.-

702

'\""-;

1

3) Dale
r-U'"

HRSI
WK

,

j

lulll

I

-

'

C>AY"mr,
Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Admmistrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursmg Ass't

2

2

8
8

2
2
2
2
5
8
8

2
2
2
2

8
8

2
8

8
8

8
8

8
4

8
4

TOTAL HOURS/ FTE-DA Y
,

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

6
4
4
8
13
0
56
48
0
139

0.15
0.10
0.10
0.20
0.33
0.00
1.40
1.20
0.00
3.48

56
40
0
96

1.40
1.00
0.00
2.40

56

1.40
0.00
0.00
1.40
7.28
..

;:,n'r'
8
8

8
8

8
8

8
8

8
8

8

8

TOTAL HOURS/ FTE-EVENING
IV/l:in (

"'LI'CT
"

Registered Nurse .
Licensed Practical Nurse
Licensed Nursing Ass't

8

8

8

8

8

8

8

a
a
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FIT PER WEEK

56
291

.~

*TBS :;;: To be scheduled

-77 -

i

y".

I

-:

-

~I

t'U;)IIIUN
, "

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

,

2
4
4
2
8

8
8

DAY <>"'1'1
2

2
4
4
2

2

,

8
8
8

8
8

8
12
12
8
20
0
40

2
4
' 4
2
4

8
8

8
8

8

56

TOTAL HOIIR C;/ FTE-DA Y

156

8

0
.

'" <>"/1' 1

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass'l

0

8

8

8

8

8

8

56

8

0
TOTAL HOURS/ FTE-EVENING
IV/uN/ ;)NIt-'

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
-

8

8

8

8

-

-

8
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTE PER WEEK

*TBS :;;: To be scheduled

.. 78-

0.20
0,30
0.30
0.20
0.50
0.00
1.00
1.40
0.00
3.90

56
0
40
0

40
252

0.00
1.40
0.00
1.40
0.00
1.00
0.00
1.00
6.30
--

i'1"" .~

5) Northern State
.

r-v<>"IUN

'.

I

MON

TUI

.
DAY~Nlr

-

-

Med ical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Adrnillistrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

6

HRSI
WK

.
4

6

8

8
8
8
8

8

8
8
8
8

8
8

8
8

8
8

8
8

!

8
8
8

8
4

8
4

TOTAL HOURS/ FTE-DA Y

.

.

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

c:

8
8

8
8

8
8

8
8

-

-

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

0.40
0.40
0.40
0.40
1.00
0.00
1.40
1.20
0.00
5.20

56
48
0
104

1.40
1.20
0.00
2.60

0
56
0
56
368

0.00
1.40
0.00
1.40

;;,nlrl

8
8

8
4

8
4

TOTAL HOURS/ FTE-EVENING

.

16
16
16
16
40
0
56
48
0
208

~n" 'I

8

8

8

8

8

8

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/PTE PER WEEK
*TBS ::: To be scheduled

-79 -

9.20
._..

'('I'"

, '
~,

~

,-~~~._--~-

~

I"U~IIIUI'l

HRSI

C>AY.:>nI,.

Medical r
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

WK

.

2

2
4
4
4

2

6
8
8
12
13

4
4
," 4
8

4
5

a
8
8

8
8

8
8

8

56
40

TOTAL Hnl JR ~/ FTE~DA y

143

8
8

8
8

8

a

FTE
0.15
0.20
0.20
0.30
0.33
0.00
1.40
1.00
0.00
3.58

I.:J .:>nlr I

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

a
8

8

8

TOTAL. Hnl

.
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8

8

. .
8

8

8

TR~/ FTE~EVENING

a

0.00
1.40
0.00

56

1.40

a
a

0.00
1.00
0.00

40
239

5.98

56

NIGHT.

8

8

8

8
TOTAL. HOURS/ FTE~NIGHT
TOTAL HOURS/FTE PER WEEK

*T88 = To be scheduled

- 80-

40

1.00

,

7) Northwest State

TUE

>N

.

.

WK

DA Y ::iNII"" r

.

Medical Director
Dentist
Dental Assistant
Physician Assistant
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

HRSI

THU

6

16
16
16
12
40
0
56
48
0
204

4

6

8

8
8
6
8

8

8
8
6
8

8
8

8
8

8
8

8
8

.
8
8
8

8
4

8
4

TOTAL HOURS/ FTE-DAY

.

.

'

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

8
8

L:r

8
8

8
8

.,n,/"",

8
8

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

0.40

OAO
0.30
1.00
0.00
1.40
1.20
0.00
5.10

.
8
8

TOTAL
..

OAO

8
4

56
48
0
104

8
4

m)llR~/ FTE-EVENING

lAO
1.20
0.00
2.60

IVIl.:IN 1 ;:,nll""1

8

8

8

8

8

8

TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTE PER WEEK
*TBS :::: To be scheduled

- 81 -

0
56
0
56

8

_.

364

0.00

lAO
0.00
1.40
9.10

'('\

1 "

8) Southeast State
HRSI
WK
Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

I

4

2

8

2
2
6
8

4

4
4
12
20

8

8

8

8

8

8

2
2
2
6
8

a
8
8

8
8

8

I

40
56

8

a
a

Licensed Practical Nurse
Licensed Nursing Ass't

I

8

I

8

8

8

8

8

TOTAL HOURS/ FTE-EVENING
Re istered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't

I

I
I
I
I
I

a

I
I
I

56

I

56

8

I
I
I
I

a
8
I

8
I

56
I

I

I
I
I
I
TOTAL HOURS/ FYE-NIGHT
TOTAL HOURS/FYE PER WEEK

*TBS:::: To be scheduled

- 82-

I

a

I

I
I

56
256

I
I

0.20
0.10
0.10
0.30
0.50
0.00
1.00
1.40
0.00

0.00
1.40
0.00
1.40
0.00
1.40
0.00
1.40
6.40

I

1":,
9) Southern State
~~~.~.,

r-V"""

•

MON

"

,

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

4

8
8

DAY"ntr
4
8
8

4

,

4
8
8

4

' 8

8

8
8

8

8

16
16

16
16

16
16

16
16

16
16

8

8

8

8

16
8

16
8

16
8

16
8

8

8

8

8

.

16
16

16
16

8
8
8
TOTAL HOURS/ FTE-DA Y

c'

20
16
16
24
40
0
112
112
0
56
396

0.50
0.40
0.40
0,60
1.00
0.00
2.80
2.80
0.00
1.40
9.90

112
56
0
56

224

2.80
1.40
0.00
1.40
5.60

96
56
0
56
208
828

2.40
1.40
0.00
1.40
5.20
20.70

~HI"'I

IV' un ,

Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

HRSI
WK

,

,

Medical Director
Dentist
Dental Assistant
Nurse Practitioner
Program Manager
Administrative Ass't
Registered Nurse
Licensed Practical Nurse
Licensed Nursing Ass't
RN - Infirmary

.

WED

16
8

16
8

16
8

8
8
8
TOTAL HOURS/ FTE-EVENING

"n,r,

16
8

16
8

16
8

16
8

8

8

8

8

16
8

8
8

8
8

8
8
8
TOTAL HOURS/ FTE-NIGHT
TOTAL HOURS/FTE PER WEEK

*TBS = To be scheduled

- 83 -

ATTACHMENT I

STIPULATION AND AGREEMENT

NOW COMES the State of Vermont, Department of Corrections, the Department of
Personnel, and the Vermont State Employees' Associi:ltion, Inc. representing the affeC!ed
employees, by and through their respective representatives, who do hereby stipulate and
agree to the following .in furtherance of their public-private partnership endeavor with
regard to the provision of medical services for the Department of Corrections. This
Stipulation and Agreement shall be considered to be part of the Corrections Bargaining
Unit Agreement.
1. That, the current, classified service, Corrections Department incumbents in the classes
listed below will continue employment in classified positions, when the contractor
commences responsibility for providing correctional health care services to the State.
Correctional Health Care Specialist A
Correctional Health Care SpecL,list B
Practical Nurse
Patient Care Intern
2. That. the contractor (or delegated representative thereof) shall be the immediate
supervisor(s) of classified employees, in the above listed classes, for all purposes under
the contract and/or any rules and regulations, and that the provisions of the Supervision
of Classified Employees article of the Corrections contract shall be waived in this case.
The contractor shall be deemed to be the delegated representative of the appointing
authority for these employees for all purposes, except that corrective action and/or
disciplinary actions will be imposed in collaboration with the Commissioner of Corrections
or his delegated representative.
3. That, ali other provisions of the collective bargaining unit agreement (including the
process for Implementing work schedule and work shift chaflges) will be applicable to
ciassified incumbents in these positions, except as otherwise indicated herein.
4. That, the parties agree to expedite discipline and performance evaluation/corrective
procedures, grievances, or schedule/shift 'change procedures by means of the existing
contractual Alternative Dispute Resolution (ADR) process, if applicable, or in some other
mutually agreeable manner. Neither party necessarily waives its right to appeal to the
Vermont Labor Relations Board in appropriate cases.
5. That, the parties agree to establisf) a "corrections health care" labor - management
committee to discuss issues and questions of mutual concern. Regular contract
provisions relating to labor/management committees will apply.
6 That, ne'ither' party waives any statutory or contractual right, prerogative or privilege
with respect to the disposition of positions in the above listed classes when they next

-84Vermont DOC Health Services RFP

1

ATTACHMENT I, cont.d

Stipulation and Agreement
Page 2
.

!Jecome vacant. Neitherparty is restrained or restricted in the exercise of any such right,
prerogative or' privilege·, by the terms of this Stipulation and Agreement.
.
.

.;'

.

7. :That, the contractor 'shall not actively recruit classified employees to work directly for
it.
.

FOR

-

!b:;;
[~J::~_~
~
~.~

THEVS~

.

. /
,

Date

.. FOR THE VERMONT DEPARTMENT OF CORRECTIONS:

.. .

FOR THE VERMONT DEPARTMENT OF PERSONNE.L:

-85-

emsa.doc 7/25/96 p4

ATTACHMENT J

SETTLEMENT AGREEMENT
L

PREAMBLE
WHEREAS, on December 13, I993,the National Prison Project (ltNPP") of the American

Civil Liberties Union (" ACL~:") brought an actio\! pursuant to 28 U.S.C. § 1331, §§ 1343(a)(3)

..

and (4), §§ 2201 and 2202,42·u.s.c. § 1983, and § 12101 etseq. to redress the'alleged
,

"

.

depriv~tion; of rights pr~tected by Jederal law and by the First,Fo~rth, Fifth, Eighth, Nirtth and
Fourteenth Amendments of the United States Constitution, G9ldsmitlt et at v. Dean, et al" No.
2: 93-CV-383 (D.Vt. filed Dec. 13, 1993) (the "lawsuit" or the "litigation"); and
, WHEREAS, on March 9, 1994, the plaintiff class was certifi~ as "persons who 'are now

or who Will in the future be c<iniined in Vermont prisons and all persons who ,are now or will in
the future be subject to the policies and practices of the Vermont Department of Corrections and
the Vermont Parole Board with respect to the Vermont Treatment Program for Sexual
Aggressors and the Violent Offender Program;" and, '
WHEREAS, the named plaintiffs and the class they represent seek to remedy alleged
unconstitutional and unlawful co\!ditions of coniinement through deciaratory and injunctive relief;
and
WHEREAS, the defendants t~ this lawsuit dispute the standing of the 'pl~tiffs to bring
this suit and the allegations that they have violated plaintiffs' rights and deny any liability, and have
asserted various defenses to th,e plaintiffs' cla.im.s, and do not admit or concede by entering into
this Agreement that any of the pl~ti£fs' rights under the United States or yermont Constitutions
or under any law or regulation are or have been violated by the State, and
WHEREAS; nothing in this Agreement is intended to, nor shall be ciJnstrued as, an

-86Vermont DOC Health Services RFP

I '

ATTACHMENT J, cont'd

admission of liability of or by any party; and
WHEREAS, the plaintiffs and the defendants are involved' in the discovery phase of the'
litigation as of the date of this Agreement; and
.WHEREAS, it is mutually advantageous for both parties to settle this dispute \¥ithout .
further discovery or a trial; .
NOW THEREFORE, in consideration for the mutual covenants contained herein the
parties to this Agreement agree as follows:

n.

DEFINmONS
1.

"Facilities" means the facilities of the DOC, which currently are:
a.
b.
c.·
d.
e.

f.
. g.
h.

2.

Northwest State Correctional Facility ("NWSCF" at St. Albans);
Northeast Regional Correctional Facility ("NERCF" at St.
JohnsbUry);
Southeast State Correctional'Facility ("SESCF" at Wmdsor);
Chittenden Regional Correctional Facility ("CRCF" at So.
Burlington);
Marble Valley Regional Correctional Facility ("MVRCF" at
Rutland);
Woodstock Regional Correctional Facility ("WRCF" at
Woodstock);
. Northern State Correctional Facility ("NSCF" at Newport);
The Caledonia Community Work Camp ("CCWC" at St.
Johnsbury).

"Impartial Expert" or "Experts" shall mean the consultant or consultants chosen by

the parties whose function shall be to determine whether the State has achieved substantial
compliance with the terms of Section IV of the Agreement for those substantive areas assigned to
that Impartial Expert.
3.

The "Parties" shall mean the State and the Plaintiffs..

4.

"Plaintiffs' Counsel" shall mean Mitchell L. Pearl, Esq., LangrOyk, Sperry & Wool

-87Vermont DOC Health Services RFP

2

ATTACHMENT J, cont'd

. Yemont, and staff att~nieys of the National Prison Project of the American Civil Liberties Union
Foundation, Washington, D.C.
5.
,6.

"Plaintiffs" shall mean the plaintiff class.
,iS tate ;' shallinean the'named defendant(s) to·this lawsuit, except the independent
" !..

medical care providersnained in the December 13, 1993, Complaint.
7.

"State's C~unsel" shail mean theAttorney General for the State ()fVernlo~t or his

designee.
"

ill.

PROCEDURE
A.

;Dismissal Of Action

8.

Upon signing the Agreement, the Parties shall seek approval of this Agreement

from the Court pursuant to Fed.R.Civ.P. 23(e).
9.

Upon the District Co~s approval, this action shall be dismissed pursuant to

Fed.R. tiv~P. 41 (a)(1)(ii). As t~ the independent medical care providers named in the December
13, 1993 Complaint, this action shall be dismissed with prejudice.
B.

Effective Date OfAgreement

10.

This Agreement shall become effective upon: (a) approval of the Agreement by the

Court; and, (b) dismissal bf the action as provided above.
C.

Litigation During 24-Month Compliance Period

11.

Except

as expressly allOwed in ~ 31

t

below, in the case offire safety at WRCF t

from the date of approval of this Agreement and during the 24-month compliance period provided
.herein, plaintiffs, individually or as.a class, shall not file any action or seek an injunction in either
state or federal court, under any federal or state law cause of action, on the basis.of any allegation

-88Vermont DOC Heaith Services RFP

ATTACHMENT J, cont'd

of fact or claim set fortli in the December 13, 1993 Complai,nt.
12,

Nothing in ~~ 9 or 11 shall' preclude an individual from seeking exclusively on his

or her own behalf: (a) damages for a'specific claim based upon operative facts occurring either
before

or after the effective d:ate ofthisAgr~inent,
~

or; (b) equitabJereliefbali,ed upon operative

! .

facts existing after the effective
date of this Agreement, including but not limited
to claims
relating
:"
' .
.
to the Vermont
Treatment
Program for Sexual
Aggressors ("VTPSA tI ), In addition, paragraph 11
. .
.'
.
.
-"

.'

-

"

.'

shall not preclude any individual odndividuals from seeking reliefunder Vermont State law
"

provided that the relief sought is not based on any allegation offact or claim set fo,rth in the
December 13, 1993 Complaint.
13.

In any action brought pursuant to ~ 12(b), above, for declaratory or injunctive

relief relating toyrFSA, the Parties shall not object to the admissiblity of the record of
proceeding in the class,action Goldsmith. et aI. y. Dean. et aI"Civ.,Actlon No.2: 93·CV·293
(D.Vt.), except as torelevan,ce, Nothing in this paragraph shall limit a party's tight to objeCt on
any grounds to the weight a court should give to the record. '
D.

Detennination Qf Substantial Compliance and ImPartial Experts ,

14.

In order to determine whether the State has reached substantial compliance with

the terms of Section N of the Agreement~ the parties agree to the appointment of no more than
four (4) Impartial Experts as provided herein. ,

..

15,

'

An InipartiaJ Expert or Impartial Experts shall: (a) monitor the State's compliance

with the specific termsofSecticin N of this Agreement; and, (b) at the conclusion of the ~4.
Month Compliance Perjod decide whether the State is in substantial compliance with Section IV
of this Agreement. The 24-MOl\th Compliance Period shall be defil)ed as follows: (a) it shall
,

-89VennClnt nnr Hp.:'llth ~p:rvlr.p:_<;: RPP

ATTACHMENT J, cont'd

begin on the effectivedaie of this Agreement and shall end'on the last day of the 24th,month
following; (b) if the last day of the 24-Month Compliance Period is not the last business day of the
month,' then the compliance
through the last business day of the month;
and,
. period shall.continue
.'
.
"

,

.,

(c) if, because oran lmpartiil.l EXpert's unavoidable inability to make his or her final determination
of substantial compliance as provided forby this 'Agreement, a determination of substantial
compliance has not been made upon the expiration of the 24.Month'Compliance Period, the
I~Partial Expert may extend'for'areasonable period not to exceed sixty days the expiration date

of the 24·Month ComplianCe Period as to the neCessary subject areas to allow for the Impartial
Expert to make promptly his or her final determina~on of substantial compliance. The Impartial
Expert shall promptly notify the Parties in writing of the extension.
Ndthing in this Agreement shall change the State'~ obligation to comply with the

16.

specific fire safety provisions relating to the WRCF, as provided in 1111 38& 39, below,'within nine
months from the effective date of this Agreement. " .
17.

The Parties agree to the selection of the folloWing lnipartial Experts for the
,

,

,

corresponding compliance areas: Robert Powitz, Section IV (B) and to select an Impartial Expert
acceptable to the Parties, as to Section IV (A) as it relates to the WRCF and the SESCF; Allen
Breed, Section IV (C); apo, Ronald Shansky, M;D:, Section IV (0) &. (E).
18.

Except as provided in ~ 39; below, 'as it ll.pplies to the WRCF, the deterrcination of '

whether the State is in substantial compliance with the terms of Section IV ofthis Agreement
shall occur on the last day of the 24-Montb.:Cbmpliance Period. '
19.

Each Imparti8J EXpert's determination of substantial compliance shall take Into

account the eXtent to which the State 'has achieved and sustained compliance during'the Course of,

-90Vermont DOC Health Services 'RFP

5

ATTACHMENT J, cont'd

the 24-Month Compliarice Period-,
20,

Six months following the effective date of this Agreement, and every nine months·

thereafter during the 24~Month CompliancePeriod, the Impartial Expert(s) shall conduct on-site .
tours o~ the Vermont Facilities. The Impartial Expert assigned 10 ,determine compliance with the '
0., •

. ':':

Fire, Safety provisions of ~eCtion IV of this Agreement shall conduct an on-site tour of the WRCF
,nine months following the effective date of this Agreement in addition to his or. her regular on-site
tours, and shall prepare a report that complies with the provisions of~ 24; below 'and includes a

..

statement indicating whether theState is in compliance with the requirements

of~~

38 & 39,

below, as they pertain to the WRCF. The State has a responsibility to permit, but does not have a
responsibility to guarantee, an Impartial Expert's attendaJice at these agreed-upon intervals.
Plaintiffs' Counsel'and the State's Counsel may each select representatives to accompany the
Impart'ial Experts during these on-site visits. Plaintiffs' Counsel shalln~t select as representatives
any employee, agent, contractor, and/or representative in any capacity of the State.of Vermont.
21.

The State shall pay fees, expeoiJes and, costs associated with the work of the

Impartial Experts up to, but in n.o event exceeding, the total aggregate amount ofS45,000.00 per
year.
22,

The Impartial EJqiert(s) may review all documents not privileged under Vermont

State law, speak with any D,efendant.or staffmember
at the DOC Facilities, and may engage in
.
'

private conversations with any dass member.
23,

Foll.owing each of the on-site visits referenced above, each o~ the impartial Experts

shall prepare a written interim report .of his or her findings within thirty (30) days and shall, send
one copy each to Plaintiffs' and the State's Counsel.

-91-

ATTACHMENT J, cont'd

Within thirty (30)" days following an Impartial Expert's final on-site visit, as to

24.

those specific areas to which the Impartial Expert haS been assigned, the Impartial Expert shall
prepare a report including a statement indicating whether, in the Impartial Expert's opiriion, the.
State is in substantial compliance with. the. specific terms ·of Section IV of this Agr.eement.
;. "~'

.

An Impartial Expert's'determinati6n of substantial complian~ shall take into

25.

account the extent to which exceptions to .compliance are isolated or noncontinuing in nature, or
are unintentional, or are th ll temporary result of actions by members. of the plalntiff class, and are
:

addressed by corrective action.
A finding of substantial compliance in one or more ofthe subject areas set forth in

26.

Section IV of this Agreement shall not be defeated by findings of non-compliance with any other
subjeet area or areas.
27.·
'i.

In the event that an Impartial Expert learns at any time of conditions that may pose

imminent and significant health or safety risks to theplalntiffs, he or she shall immediately report
such conditions to the Commissioner.of the Department of Corrections and to counsel to the
parties.
28.

If counsel to either party' communicates With an Imp.artial Expert, counsel shall

promptly prepare and produce to co~l to the other party memoranda of conversations and
copies of all written communications with the. Impartial Expert.
29.

The State shall afford the Impartial Experts reasonable access to the State's

Facilities: documents, staffand inmates and the parties shall provide their full
. . cooperation to the.
Impartial Experts, to enable them to carry oUt their responsibilities.

-92Vermont DOC Health Service, RFP

7

, ATTACHMENT J, cont'd

E.

En-ect Of A Detennination Of Substantiltl Compliance.

30,

If, upon the expirati~n of the 24-Month Compliance Period, or in the ~e of fire

safety at WRCF, folJowingthe nine ~onth on-site tour pursuant to ~ 20, above, and ~,~ 38 & 39, '
, below, an Impartr~1 Expert finds that the state is in substantial, compliance with any of the subject '
, ,

,?

areas of Section IV of this Agreement, as to any such subject area such a finding shall be a

compl~te defense to any class action complaint by the plaintiffs, having the same effect as a
dismissal with prejudice by stipulation of the class action Goldsmith. et ai, v,

PM et aL Civ.

"

Action No.2: 93-CV-293 (D.Vt.), pursuant to Fed.R.Civ.P. 41(a)(1)(ii) .

..
31.

If, upon the expiration of the 24-Month Compliance Period, or in the case of fire

safety at WRCF, following the nine month on-site tour pursuant to ~ 20, above, and m)3 8 & 39,
below, an lmpartiaLExpert finds that the State is not in substantial compliance with'any of the
subject, areas of Section IV of this Agreement, the plaintiffs may file a complaint seeking
relief
.'
,
with respect to those areas for whiCh that Impartial Expert has determined that the State is not in
compliance.
31.

The parties agree to accept and be bound by the detenninations of the Impartial

Experts.

F.

Plaintiffs' Counsel Access To Clients

33.

During the 24-Month Compliance Period of this Agreement, Plaintiffs"coWlSeJ

,reserve their right to meet with their clients privately.
G.

Remedies and Expiration Of Agreement

34.

Either of the Parties may commence, by and through t):le Plaintiffs' or the State's

Couf\sel, an action to enforce the te~s of Section ill alld V o(this Agreement; provided however

-93o

ATTACHMENT J, cont'd

that: (aJ any such action for breach of this Agreement shall be filed in the Washington Superior
Court in the state ofYermont; and, (b) the exclusive remedy available in any such action shall be
limited to specific performance.
.35.

Prior to .filing'·any such action under the preceding paragraph,.the Parties shall
'

~,

.

'

'. \
"

make good faith efforts to resolve the dispute.
36.

In any such action described in ~ 34, above, each party shall bear its oWn costs and

37.

Except for ~~ 26, 30, 31, 32, 89,and Section VI, this Agreement shall expire and .

fees .

.

be o£no force or effect upon the expiration 'ofthe 24-Month COmpliance Period.
IV.

COM:PLIANCE AREAS
A.

Fire Safety

3&.

The State shall comply with the Yennont Fire Prevention and Building Code,

which incorporates by reference and amends nilevant portions of the (a) Building Officials and
Code Administrators National Building Code; (b) National Fire Prevention Association ("NFPA")
National Fire Prevention 0lde; and, (c) NFPA Life Safety 0lde, as it is applied to the Yennont
prison system by the State ofYermont Department of Labor and Industry.
39.

Within nine'months ?fthe effective date of this Agreement the State will make

specific physical plant modifications to the ~CF which are necessary to comply with ~ 38,
above, in response to the Depart!\1ent ofLabor and Industry Audit for tlie WRCF dated JanuarY
5, 1996, a copy ofwruch shall be provided to the Impartial Expert assigned to determine
compliance with the Fire Safety provisions oftrus Agreement. Prior to the expiration of the 24Month Compliance P~riod, the State will make specific physical plant modifications to the SESCF

-94Vermont DOC Health Services RFP

9

ATTACHMENT J, cont'd

which are necessary
to comply wlth
~ 38, above, in response to the Department of Labor and
.
' . ,
industry Audit for the SESCF dated January 5, 1996, a copy of which shall be provided to the
impariial Expert assigned to determine compliance with the Fire Safety provisions of this
Agreement.
If a failure by the State to m~t tlie requirements of~~ 38 & 39, above, is due to

40.

unavoidable construction delay(s) beyond the control of the State, and work is otherwise
pr~ceeding

to completion; the lmpartial,Expert may, in his discretion, extend for up to sixty (60)

days the nine-month compliance period established for the WRCF.
EnyironmentalHea1th and Safety ,

B.

The State shall sufficiently maintain and repair, as';eeded: plumbing at WRCF,

, 41.

CRCF, NERCF)v1VRCF, NWSCF, and SESCF.
42. '

The State shall sufficiently maintain'and clean, as needed, the ventilation systems at

CRCF, NERCF, MVRCF,WRCF, and NWSCF.
The State shall sufficiently maintain the beating system so that it is capable of

43.

regulating temperatures throughout the facilities at WRCF, MVRCF, NERCF, and SE8CF.
The State shall take reasonable measures,' including necessary repairs, to av~rt the

44.

backup of sewage at WRCF, CRCF, and SESCF.
45.

The State shall sanitize mattresses between users and replace or repair, as needed,

,torn and dirty mattresses at WRCF, CRCF, NERCF, MVRCF, and SESCF.
'46.

The State shall provide mattresses made of fire retardant material at WRCF.

47.

The State shall provide, as needed, inmates with mattresses that fit the bedframes

atMVRCF.

-95VPTmnnt

nnr UP~ Hh .~prv-irp~ "RH'P

ATTACHMENT J, cont'd

48.

The State shall
maintain a program for vermin and insect control and e;<tennination
. ,

in the kitchen and food storeroom at WRCF.
49.

The State shall require that kitchen workers
ccver. their hair at
CRCF.
.
.

50.

The State sh~l repair, as needed,..any.1eaks.to the roof.over B: andD pods at
.

"

.

.

'

.

MYRCF.
51.

The State shaH repair, as needed,. windows at MVRCF.

52.

The State shall maintain sufficient food temperatures at MVRCF.

53.

The Impartial Expert touring the facilities referenced herein, Le., WRCF, CRCF,

MYRCF, NERCF, SESCF, and NWSCF, in.addition to monitoring the State's substantial
ccmpliance with the specific items listed herein, shall determine whether the State maintains
sufficient.levelsof.enwonmental health and safety at these facilities.

~.

C.

Crowding andSystemic CorrC£tion~1 Msues

1.

Exercise

54.

The
make
available, for those inmates 'housed in the general
population
. State shall
.
.
.

with a custody.and security. rating of medium or lower, and'with no disciplinary sanction limiting
outside recreation inforce,not less than
.

.

' , .

~even hours ofoutsiderecreadon per week, '''.:

,opt in.'

,

.

emergency or adverse weather Conditions not Conducive to outside recreation. The State sh;J1l
.

.

provide all prisoners with access to. out-of-ceU time, during which .the prisoners may exercise, no
.Iess than one hour per day, five days per week.
2,'

Overcrowding of Women Prisoners

55.

The State shall provide adequate and safe housing for women prisoners.

.'.
Vermont DOC Health Services RFP

-9611

ATTACHMENT J, cont'd

3.

AmeriCans With Disabilities Act

56.

The State shall ensure, to the extent required by the Americans :vith Disabilities

Act (ADA), that inmates with disabilities are not excluded from participation in, or denied the
benefits of services, programs; or actiVities because of their disabilities.
. 1 ",

.

4.

Use of Force and Restraints

57.

The State shall videotape cell eXtractions and uses of force in accordance with

.

DOC Directive No. 413 .02, . dated September 22, 1993,' and shall maintain these videotape records
of any cell extractions and uses offorce in the DOC's possession upon the effective date oftills
settlem~nt agreement and

any record~ during the 24-Month Compliance Period for at least as

long as neces~ to allow reasonable access. to the videotapes by the lmpartiB.1 Experts.
58..

The State shall forbid the restr~t of inmates by securing an inmate's hands behind

bis or her back and securing the inmate's ankles to bis or her wrists.
5.

Areas Not Designed As Liying Areas

59.

Areas in DOC Facilities not originally designed and built for housing 'inmates shall

not be utilized for the housing of inmates without neces~ redesign and remodelling.
D.

Medical Care

1.

Standard of Care

60.

The State shall provide inmates with health care in accordarice with constitUtional

standards. Nothing set forth below shall prevent the State from implementing additional
proe¢dures which will improve the provision of health care to inmates.
2.
61.

Quality Assurance
. The State shall establish and maintain a system to assure the qualitY ~fmedical
,"

.

-9710

ATTACHMENT J, cont'd

care for inmates, The quality assurance program shall be designed to ensure thal the provision of
medical care to inmates meets the standard set forth above in ~ 60.
3.

Medical Administration

.62.

The State shall employ.or otherwise contract for· a licensed .physician or a team .
: ,~ .

comprised of a physician and 'other medical professionals with a Health Care Organization (HCO)
to serve

as Medical Director to the State's prison system. The Medical Director or HCO shall

institute centralized health care policies and shall review health care staffing levels and operations

--

at each facility and s~ be responsible for overseeing the quality assurance program.• In addition,
the Medical Director shall oversee the clinicaltreatment of priscners. .
'.

63.

The State shall maintain adequate policies, directives and procedures for medical

care throughoutthe system, including policies, directives and procedures for the treatment of
inmates with chronic diseases and inmates
who require .specialty care.
.

64.

The State shall maintainliaiscns with local hospitals.. The State shall ensure an

adequate and appropriate response for all inmates who need immediate medical attention and shall
maintain 24-hour access to emergency room Care:
4.

Intake

65.

The Stat.e shall conduct timely and adequate intake screening for inmates by

qualiJied med.icaJ personnel. The screening shall include an appropriately administered test for
tuberculosis.
66.

The State shall use best efforts: (a) to screen newly-admitted female inmates for

sexually-transmitted disC4Ses; and, (b) to provide such inmates with pap tests and urinalysis
pregnancy screening.

-98Vermont DOC Health Services RFP

13

ATTACHMENT J, cont'd

·67.

The Sla·t.e shall conduct an intake physical assess~ei1t by qualified me<lical

personnel.
5.

Eyeglasses

.68.

The State shall provideeyeglasses·to inmates in accordance with DOC Procedure

No. 4l2PP, dated March 2; 1992..

.

.
•

6.

Dental Care

69.

The State shall provide dental care to treat inmates' known serious dental needs..

70.

The State shall schedule a comprehensive dental screening of all prisoners.within

60 days of admission.

71.

The State shall provide toothbrushes, toothpaste, and dental floss for all prisoners,

except when reaSonably deemed a security, custOdy, or safety risk by the DOC.
7.
~

MediMIReeords

72.
The State shall maintain a standardized format for medical records including, but
not limited to:
.
..

a.
b.
c.
d.
73.

lab test results;
medical flow charts;
m~ical history, and;
physical exam information.

The S(.ate shall protect the coimdentiality ofmedical records and medical

information.
8.

Thera'peutic Diets

74.

The State shall maintain therapeutic diets based upon medical staff orders.

9.

CPR Trnining

75.

The State .shall provide CPR training for all medical staff and correctional officers.

-99- .

ATTACHMENT J, cont'd

10.

lnrectious Disel\se Trl\ining

76.

The State shall provide training to corrections and medical staff on infectious

diseases such as tuberculosis, hepatitis and AIDS.
11.

HN Care ..

77.

The State shall offer voluntary testing for AIDS and shall provide appropriate care

to illY positive inmates.
12.

Women's Health Care

78.

The State shall provide women prisoners access to: (a) gynecological and '. rerratal

care; (b) breast examinations and mammograms for age-appropriate or symptomatic inmates; and,
(c) routine pap tests.
13.
79.

··Medication Distribution.
The State shall maintain an appropriate medication clistribution system. The State

sh.all ensure that asthmatic inmates have access to inhalers and inmates with coronary conditions
have access to nitroglycerin or other prescribed medication.
E.

Mental Health Care

80.

The State shall provide prisoners with mental health care in accordance with

constitutional standards. Nothing shall prevent the State from doing more than what is required
in this Agreement.
81.

The State shall maintain policies and directives for screening,' evaluation, houslng,

and treatment of inmates with.serious mental illnesses and those indicating withdrawal from
alcohol and drugs. This paragraph does not apply to individuals lodged pursuant to 33 V.SA
§708(d)(I) & (2).

-100Vermont DOC Health Services RFP

15

ATTACHMENT J, cont'd

82.

A suicide risk ass'essment shall be conducted bi' appropriately trained staff during

the admission
process utilizing the current Initial
a copy ,
ofwhlch shall be
,
.
. Needs Survey form,.
'

pro;";ded to the Impartial Expert assigned to evaiuate compliance with this Mental Health Section.
.

'.;

.83.

- .

'

. :

'"

The State. shall maintain a 'system to assure the' quality of mental health care for .
.!

.' .

.

.

.

inmates. The quality as.sunince program shall be designed to ensure that the provision of mental
health care to inmates meets the standard ~et forth above in ~80.
.,'

84 .

All inmates shall be adequately screened for any signs of serious mental illn.ess.
,

85.

,.

'

,

t·

.

The Stat~ shall maintain liaisons ·with locai hospitals. The State shallens~re an

adequate and appropriate response for all inmates who need immediate mental health care, and
shall maintain 24-hour access to on-call emergency mental health care.
86.

The State shall maintain' written policies, directives and procedures for suicide

prevention.
87..

The State shall maintain appropriate policies, directives, and procedures governing

distribution and review of psychoactive medication; informed Consent; and, evaluation,
observation and treatment of suicidal prisoners.
. 88.

The State shall provide a Secure Care Unit ("SCU") and art Intermediate Care Unit

("ICU"), to be adequately staffed with qualified mental health professionals and specially trained
correctional personnel.

v.'

ATTORNEYS'l)"EES

89.

Without any admission, implication, or suggestion by the State ofliability or that

the plaintiffs are a.prevailing party pursuant to 42 U.S.C. §1'9'88, the State agrees to pay and the
plaintiffs agree to accept a payrrient 6f one hundred ninety five thousand dollars ($195,000,00) to
-101-

ATTACHMENT J, cont'd

be made in three payments, the first to occur on or before July I, 1996 in the amoun\ of twenty
five thousand dollars ($25,000,00), the second to occur on or before June 30; 1997 in the amount
of $35,000,00 and the third to occur on or before July 31, 1997 in the amount of $85,000.00 to
, I

.

.

"

.

the National
Prison Project',
in full . satisfaction
of any and all claims or demands 'for any arid an ' '
'.
. . :..
...

.;

fees,
costs, and/or
Project,. its agents, assigns"or
those acting in
.
' expenses that the National. Prison
.
.
its pl~ce, have claimed in the' past, have now, or could have in the future, up to and including the, ,
expiration of the 24-Month Compliance Period, ~ full settlement of any and all potentialf~ and
.

J

.

.

..

cost demands that have been or could be made by the plaintiffs in the action Goldsmith. et al, v,
Dean. et aI., Civ, Action No. 2:93-CV·3'83 (D.Vt.).
VL

MISCELLANEOUS
90,

-, This Agreement is a document which all parties have negotiated and drafted and ,

since all parties participated equally in drafting itsierms" the general rule ofconstruction
interpreting a document against the drafter shall not be applied in future iriterpretation of this
Agreement.
91,

This Agreement

represent~

the entire and ,only Agreement between the parties in

Goldsmith, et al. v, Dealb et al.. Civ. Action No. 2: 93~CV·383 (D.Vt.). All prior agreements,
representations, statements, negotiations, and understandings shall ha~e no effect.
,

, 92.

'

No changes, modifications, or ~endments to the terms and conditio~s of this

Agreement shall be effective unless reduced to writing, number~ and signed by Plaintiffs', Counsel
and the State's Counsel.
93,

The law of the State of Vermont regarcling the construction of contracts shall

govern any dispute regarding the construction ofthi's Agreement.

,
Vennont DOC Health Services RFP

":10217

ATTACHMENT J, cont'd

94,

None of the terms contained' in this Agre'ement, such as "agree," "shall,," "will,"

"establish," "implement," "continue,': "maintain," and/or any combination or modification of these
. terms as used in this Agreement, nor the assumption of any obligation. contained withinthe
Agreement, implythat the,S~ate is not now doing or must do any of the items contained in this'
Agree:nent in order to corrtply with the United States or Vermont Constitutions or any statute or
regulation.

..

95.

The .Court's. approval of the dismissal of this action is sought to comply
with Rule
,

23(e) of the Federal Rules of Civil Pro'cedure. This Settlement Agreement is not a consent decree
nor do the parties intend it to be construed as such. It does not operate as an adjudication of the
merits of the litigation.
96.

This Agreement shall not be construed as contemplating, requiri.ng or causing the
,

relinqui~hment

.

or ceding of any control by the State of Vermont over any facility or activitY of the

DOC.

97.

The terms of thiscontract are not severable and the finding that any terms

contained herein are illegal or void shall work to defeat all of the terms contained herein.
,

98.

I

By the signatures below and for the consideration contained herein, the Parties

agree to be bound by the' terms and ~nditions of this Agreement.

-103, n

ATTACHMENT J, cont'd

VII.

Authority
99.

The undersigned representatives of each party to this private agreement certifY that

each is fully authorized by the party or parties he or she represents to enter into the terms and
,'

conditions of this' settlement agreement and to execute and bind that· party to it.
ST AT~ OF VERMONT

..

JEFFREY L. AMESTOY
ATIORNEY GENERAL

DEPARMENT OF CORRECTIONS
J 03

South Main Street
Waterbury, Vermont 05671

109 State Street
Montpe ier, Vermont 05609

By:'

BY:'

W\.~

David M. Rocchio.
Assistant Attorney General
For the Defendnnts

ommissioner
For the Defendants
DATED:

DATED:

By:

By:
aIJ'e
n
Attorney for Plaintiffs
National Prison Project ACLU Foundation
1875 Connecticut Avenue,.N.W. Suite 410
Washington, D.C. 20009

DATED:

~&

.i"fitclleiiCPeari

Attorney for Plaintiffs .
Langrock Sperry & Wool
15 South Pleasant Street
Middlebury, Vermont 05753
DATED:

-104,n

'0;;

'V~
1-:

Attachment K

Staffing Coverage Standards

Da

PA
RN

.

'--~t~~ ~:~

I

LPNI~ 4Q~t-56 ~f'!\!+_iO I LPIT~

·~·-1-----

56

"".

56

~1i'.~t=~(,- -. I~;:_._ 56

The above matrix reflects Contractor's Staffing Matrix (Attachment H) for PAs, NPs, RNs, LPNs and LNAs with the reduction of forty hours per week or the
equivalent of one (1) FTE per shift for the highlighted positions. The intent of Attachment K is to provide a definition of an uncovered shift For highlighted
positions, Contractor wi1l be in compliance if only one (1) of two (2) scheduled individuals of the same title are present for the shift.. Should Contractor be unable
to fill all positions as scheduled in Attachment K, a performance penalty will be incurred. Contractor may, at its discretion, fill clinical positions with higher
practice level professionals - charging the DOC at the cost of the regularly scheduled health profession - without penalty.

- 105 -

Attachment L

Independence, Liability, Hold Harmless Clause
According to Attachment C, Paragraph 5, Independence, Liability: "The Contractor will act in an
independent capacity and not as officers or employees of the State. The Contractor shall indemnify,
defend and hold harmless the State and its officers a.nd employees from liability and any claims,
suits, judgments and damages, which arise as a result of the Contractor's acts and! or omissions in
the performance of services under this contract."
Attachment C, Paragraph 5 of this contract pertaining to defense and indemnification is intended by
the parties to include (i) defense of all claims, and! or lawsuits, including but not limited to actions
for damages and! or for declaratory or injunctive relief, to the extent that they contain allegations that
arise as a result of the Contractor's negligence in the performance of services under this contract
and! or intentional misconduct in the performance of services under this contract (intentional
misconduct to include, without limitation, any intentional violation of law or duty of care to any
inmate) whether or not the Contractor, an employee of the Contractor, or a subcontractor of the
Contractor is a named party to the action and (ii) indemnification to the extent that any such claim or
lawsuit results in a final determination, and! or settlement, that liability arose as a result of the
Contractor's negligence in the performance of services under this contract and! or intentional
misconduct in the performance of services under this contract (intentional misconduct to include,
without limitation, any intentional violation of law or duty of care to any inmate) whether or not the
Contractor, an employee of the Contractor, or a subcontractor of the Contractor is a named party to
the action. The pilrties do not intend Paragraph 5 to include liability
for allegations that
arise as a result of the acts (including intentional misconduct), omissions, policies, procedures or any
other conduct attributable to the State, its agents, officers or employees.
If the Office of the Attorney General or other representative of the State tenders, in writing, a claim
~·..and! or lawsuit to Contractor for defense and indemnification in accordance with the aforementioned

paragraph, the Contractor shall respond, in writing, to the Attorney General or State within ten (10)
business days of such tender. In the event a response to the claim or suit is required prior to the
expiration of the ten (10) business days period of time, including but not limited to court action, the
Contractor will be so notified. The Contractor's response to the Attorney General's or State's
tendering of any such claim or lawsuit shall include an acknowledgment of receipt of the claim
and! or lawsuit, a response on whether Contractor will accept or decline the tendering of any such
claim and! or lawsuit and, if accepted, the identity of counsel retained to defend any such claim
and!or lawsuit.

In the event the Contractor does not comply with any aspect of this provision, and such noncompliance also constitutes a material violation of this provision, as so determined either judicially or
by mutual agreement of the parties, the Contractor shall be responsible for any and all costs and! or
fees that were reasonably-incurred by the Attorney General's Office and! or the State as a direct
consequence of such non-compliance.

- 106 -

The Contractor agrees to cooperate with the Office of the Attorney General and the State in the
investigation and handling of any claim and/ or lawsuits filed by inmate(s), and/ or other person(s)
and/ or entity or entities in cOlmection with the Contractor's performance of services under this
contract. The Office of the Attorney General and the State will monitor the defense of all claims
and/ or lawsuits and the Contractor and defense counsel shall cooperate fully with such monitoring.
The Office of the Attorney General and the State retain the right to participate, at their own expense,
in the defense and/ or trial of any claim and/ or lawsuit where the Contractor is providing the defense
and indemnification of such claim and/ or lawsuit. The Office of the Attorney General and the State
shall have the right to approve all proposed settlements of such claims and/ or lawsuits, which are
being made against the State and/ or State employees. In the event the Office of the Attorney
General or the State withholds such approval to settle any such claim and/ or lawsuit then, the
Contractor shall proceed with the defense of the claim and/ or lawsuit but, under those
circumstances, the Contractor's liability and indemnification obligations shall be limited to the
amount of the proposed settlement.

- 107 -

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