Follow-up audit finds persistent gaps in prison health care; auditors recommend further oversight and a two-year follow-up

Auditors presented a second in-depth follow-up of health care services in Utah state prisons and recommended additional oversight and another in-depth follow-up in two years.

Brian (audit presenter) told the subcommittee the 2021 audit and a 2023 follow-up led to 25 recommendations overall; auditors found 18 recommendations still in process. He said the audit’s clinical reviewer concluded the system is “adequate” but identified continuing systemic deficiencies. “Fifty percent of the inmates that he reviewed received inadequate or inappropriate care,” the auditor reported, an increase from 17% in 2021; shortcomings included lack of documentation (“if it wasn't charted, it didn't happen”), delays in timely care, inadequate follow-up and vague monitoring orders.

Auditors highlighted diabetic care concerns at the Utah State Correctional Facility where insulin and meal timing sometimes diverged by more than the professionally recognized 30-minute standard, increasing hypoglycemia risk. The team recommended improved coordination modeled after practices observed at the Gunnison facility, where meal–medication timing coordination was better.

Medication handling and controlled-substance controls also drew auditor concern. Auditors reported improper disposal of medications and unsecured biohazard bins in several observations, showing persistent procedural lapses. The audit found the barcode medication-scanning process was implemented but not consistently used; some staff skipped scanning barcodes for controlled substances to save time, leaving charting gaps. Auditors called for more frequent chart reviews and stronger internal controls and training for EMTs and staff who administer controlled substances and insulin.

On administrative matters, auditors noted progress: updated policies, 75 new standard operating procedures with 92 more in process, and improved performance metrics. However, auditors said some performance metrics submitted to the Legislature needed revision and that CHS per-inmate expenditures rose by an average of $2,340 over three years; auditors attributed increases to personnel costs, medication prices and outside provider costs and expressed concern about the 2024 hiring freeze’s operational impacts.

Tracy Gruber, executive director of the Utah Department of Health and Human Services, and Deputy Director Becky Brown acknowledged ongoing challenges while emphasizing operational improvements and partnership with the Department of Corrections. Gruber said the department had regular monthly meetings with corrections and welcomed the auditors’ partnership: “We know that there is more work to be done. We have some challenges and, we are confident that in the direction that we are moving, in 2 years, those, those issues that have been raised…you're going to find that the transition and the work that's been done is going to make sure that all of those recommendations have been fully implemented.”

Legislators asked what steps at the legislative level would help move outstanding recommendations to completion; auditors and directors said the Legislature had already increased funding and leadership changes had helped. The committee approved motions to refer a second in-depth follow-up audit to relevant interim committees and to prioritize a two-year follow-up audit; both motions were made by President Adams and approved by voice vote.